A Brief Primer on Spinal Cord Injury
Injuries to the central nervous system (CNS), the brain and spinal cord, are arguably the worst survivable injuries to the human body. Prior to World War II, such injuries were death sentences. Spinal cord injuries were hardly treated surgically in the First World War; injured persons were left to die. During the Second World War, a more enlightened approach was pursued, and the early beginnings of special spinal cord injury (SCI) management and rehabilitation began (Bedbrook 1987). The availability of modern antibiotics after the war and progressive improvement in clinical management lengthened the lives of injured people, but did not improve their outcome. This area of research, in my opinion, is the last frontier for the medicine of trauma. A decade ago, substantial third-degree burns could be a death sentence. Now there are artificial skins replating denuded regions of the body and saving lives. Over a decade ago, a chronic fracture nonunion that continually failed to respond to management would lead to amputation. Today this is rarely the outcome. There has been no such movement in the area of CNS trauma management. Even the much ballyhooed administration of high dosages of a steroid — methylprednisolone sodium succinate (Bracken et al. 1990) — has fallen on hard times and may not survive as a treatment of choice (discussed in Chap. 4, “Treating the Acute and Chronic Injury: Historical Perspective”; see Short et al. 2000; Pointillant et al. 2000).