What is the pathophysiology of spinal cord injury (SCI)?

Updated: Nov 01, 2018
  • Author: Lawrence S Chin, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Answer

Spinal cord injury (SCI), as with acute stroke, is a dynamic process. In all acute cord syndromes, the full extent of injury may not be apparent initially. Incomplete cord lesions may evolve into more complete lesions. More commonly, the injury level rises 1 or 2 spinal levels during the hours to days after the initial event. A complex cascade of pathophysiologic events related to free radicals, vasogenic edema, and altered blood flow accounts for this clinical deterioration. Normal oxygenation, perfusion, and acid-base balance are required to prevent worsening of the spinal cord injury.

Spinal cord injury can be sustained through different mechanisms, with the following 3 common abnormalities leading to tissue damage:

  • Destruction from direct trauma

  • Compression by bone fragments, hematoma, or disk material

  • Ischemia from damage or impingement on the spinal arteries

Edema could ensue subsequent to any of these types of damage.


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