Critical care and perioperative management in traumatic spinal cord injury

Robert D. Stevens, Anish Bhardwaj, Jeffrey R. Kirsch, Marek A. Mirski

Research output: Contribution to journalReview articlepeer-review

77 Scopus citations


Traumatic spinal cord injury is frequently associated with brain injury and with alterations in respiratory and cardiovascular function that require critical care management. Complications include respiratory failure, atelectasis, pneumonia, neurogenic shock, autonomic dysreflexia, venous thromboembolism, and sepsis. While complications may be managed with supportive care, the goal of ameliorating neurologic outcome has proved elusive. Methylprednisolone, when instituted <8 hours after traumatic spinal cord injury, was associated in two clinical trials with statistically significant improvements in motor scores at 6 months and 1 year; however, critical reappraisal of these data raises questions about their validity and clinical relevance. Until more evidence of clinically effective therapies is available, acute management must be driven by pathophysiologic principles, with emphasis on interventions that attenuate secondary neurologic injury; these include the rational use of immobilization, cautious airway management, and promotion of cord perfusion and oxygenation with the appropriate level of hemodynamic and respiratory support. Clinical trials of pharmacologic neuroprotection have yielded disappointing results, but the ongoing elucidation of spinal cord repair and regenerative mechanisms suggests new therapeutic prospects.

Original languageEnglish (US)
Pages (from-to)215-229
Number of pages15
JournalJournal of Neurosurgical Anesthesiology
Issue number3
StatePublished - Jul 2003
Externally publishedYes


  • Anesthesia
  • Critical care
  • Perioperative management
  • Spinal cord injury

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Anesthesiology and Pain Medicine


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