Early management of acute spinal cord injury

Early management of acute spinal cord injury

Editorial Acute Spinal Cord Injury Obviously the most important goal in treating patients who are paralyzed as the result of injury to their spinal c...

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Acute Spinal Cord Injury Obviously the most important goal in treating patients who are paralyzed as the result of injury to their spinal cord is to reverse the paralysis whenever possible. The rehabilitation and domiciliary care of those with permanent paralysis are of much less importance. As yet, no satisfactory regimen of treatment for recently injured patients has been developed. Progress has been made. The importance of stabilization of the fractured spine is now recognized. The value of surgical intervention in those patients whose condition is growing worse is also apparent. The fact still remains that those whose lesions are functionally incomplete and, on rarer occasions, those with complete functional lesions can improve, even recover. It is also apparent that optimal improvement can only be obtained if treatment is begun very early after the injury, certainly within the first few hours. This paper by Hall and Braughler sheds welcome light on the possibilities of treatment of these patients with steroids. The pharmacologists who have written this paper have thrown down a challenge to which the neurosurgical com-

munity must respond. They have indicated the course of treatment which should be followed. Neurosurgeons must accept this challenge and investigate this form of treatment clinically. In the United States, the Veterans Administration has some eighteen so-called spinal cord injury units. These are not true spinal cord injury units. They are domiciliary units that provide a modicum of rehabilitation. None of these units offer adequate facilities for the care of those with recent spinal cord injuries. They could, but they do not. The Veterans Administration must improve their facilities to provide care for any patient with a recently injured spinal cord. Because of the necessity for very early, prompt, and proper treatment in such cases if reversal of the paralysis is to be obtained, every patient with a recent injury who applies to them must be admitted. The limitations of time are such that proper treatment should not be delayed so that veteran status can be determined. Paul C. Bucy, M.D., Editor

Book Review Early Management of Acute Spinal Cord Injury Edited by Charles H. Tator, M.D. New York, Raven Press, 1982 444 pp., $41.00 Reviewed by Paul C. Bucy, M.D., Editor This is a much needed and most timely book. All too often, cases of spinal cord injury do not receive the attention and the care of neurological surgeons which they require. This is particularly true of the acute cases to which this book is devoted. This book has been written by 33 authors, most of them at the Acute Spinal Cord Injury Unit in Toronto. This large number of authors representing a variety of medical disciplines constitutes both the strength and the weakness of this book. These authors have assured that various aspects of the problem are presented. At the same time, any book with somany authors must of necessity lack the cohe-


sion and organization that can be achieved with texts written by one to three authors. The book is divided into several sections: (1) Clinical Assessment, Mechanisms and Types of Spinal Cord Injury; (2) Radiological Diagnosis; (3) Neurophysiological Diagnosis; (4) Principles of Treatment; (5) Halo Devices; (6) Urological Care; and (7) Surgical Management. This book should be read by all neurological surgeons and studied carefully by all those who are responsible for the care of patients with spinal cord injury. Currently many patients with spinal cord injuries are under the care of those in other medical specialties. All too often the importance of prompt, early treatment, immobilization of the fractured spine, and the avoidance of various complications are not appreciated. The care of patients paralyzed by injury to their spinal cords still leaves much to be desired. This book will help to improve that care if its words are read and followed.