[Pathophysiology and treatment of spinal cord medulla injuries]

In view of the ever increasing incidence of spinal cord injuries and their very high socioeconomic costs studies are conducted for reduction of their consequences. In recent years considerable advances have been achieved in their treatment. The contribution of various mechanisms damaging spinal cord is known presently rather well, with isolation of two groups of causes: one is the primary spinal cord injury as a result of direct force acting on it during trauma, the other is secondary damage caused by vascular changes following trauma, free radicals, calcium distribution changes, participation of opioid receptors and inflammatory process. For counteracting these mechanisms in secondary cord damage treatment with drugs is justified. Among the drugs the main role is played by steroids--both glucocorticoids and non-glucocorticoids /lazaroids or aminosteroids/. Other drugs include calcium channel blockers, opioid receptor antagonists, serotonin antagonists, cyclo-oxygenase inhibitors, osmotically active drugs, antioxidants, NMDA receptor antagonists. Besides drugs hypervolaemia, haemodilution and hypothermia are tried. Proper diagnostic procedures and effective treatment of cord injury consequences depend on the knowledge of the mechanisms of later consequences of cord injury, this enables achieving of ever more effective treatment results.