Management of acute spine and spinal cord injuries. Old and new concepts

The modern, positive approach to treatment of injuries of the cervical spine and spinal cord has produced excellent long-term survival, but less progress has been made in reversal of the neurologic defect. Injuries to the spinal column are of four types: flexion-dislocation, hyperextension, vertical compression, and rotation. Those to the spinal cord also involve four categories: morphologic damage, hemorrhage and vascular damage, structural changes, and biochemical response. Experimental work has explored new adjuncts to conservative treatment, such as norepinephrine antagonists, other drugs, and hypothermia. These results, and those of surgery on the experimental lesions, have been hopeful, but not definitive. Controversy surrounds the surgical vs nonsurgical treatment of clinical spinal cord injury. Operation is indicated for roentgenographic evidence of bone fragments in the spinal canal, for worsening neurological symptoms, and, possibly, if experimental evidence is to be followed, for surgical decompression in the very early minutes or hours after injury.