Pharmacotherapy in the acute phase of secondary spinal cord injury: an updated narrative review

Following primary spinal cord injury (SCI), spinal neuronal tissues and their surrounding tissues undergo pathological degeneration, known as secondary SCI. Secondary SCI is a complex process involving progressive neurodegeneration caused by ischemia, inflammation, and oxidative stress. Current strategies for managing secondary SCI are debated, and evidence remains limited. This narrative review discusses the latest evidence on pharmacological approaches to the treatment of the acute phase of secondary SCI. Erythropoietin (EPO) significantly enhances outcomes in secondary SCI, resulting in higher motor scores and a reduction in the American Spinal Cord Injury Association Impairment (ASIA) scale. Although methylprednisolone is one of the most commonly used drugs in secondary SCI, its effectiveness continues to be debated. Topical application of the rho-GTPases inhibitor VX-210 at the injury site showed no efficacy in secondary SCI. Similar results were observed with levetiracetam. Monosialotetrahexosylganglioside (GM1) has been linked to improvements in neurological and motor recovery. Riluzole demonstrated higher and better motor and sensory scores and improved impairment grading. The use of granulocyte colony-stimulating factor (G-CSF) enhanced motor and disability scores, promoted motor recovery, and was associated with fewer therapy-related complications. Hepatocyte growth factor (HGF) aids in motor function recovery, particularly in the lower limbs. Future progress in the pharmacological management of the acute phase of secondary spinal cord injury will depend on methodologically robust clinical trials with improved patient stratification, standardised therapeutic windows, and clinically meaningful outcome measures.