Pharmacologic Neuroprotection in Patients with Spinal Cord Injury and the Efficacy of Early Decompressive Surgery

Traumatic spinal cord injury (SCI) is characterized histopathologically by primary and secondary injury cascades. To lessen the severity of the latter, various therapeutic agents and surgical strategies have been recommended. This article reviews the efficacy of various pharmacologic agents as well as the timing of surgical decompression on neurological recovery following SCI. Based on the current understood levels of evidence, the use of methylprednisolone given within 8 hours of injury should be considered a practice option due to the lack of definitive evidence supporting its efficacy in terms of neural preservation and recovery. Additionally, early surgical decompression (<24 hours) has not been shown to improve neurologic recovery in the setting of a traumatic SCI.