Page 20 - ITPS-7-1

INNOSC Theranostics and
Pharmacological Sciences Spinal cord injury without radiological abnormalities

motor complete injuries (Grades A and B) . The MRI is essential and should be universally adopted across all
[42]
features help to classify the severity of the injury, as they can health-care facilities [56,57] .
reveal various conditions, including normal appearance, After a spinal cord injury, paramedic staff should
edema, hemorrhage, soft-tissue injury, or contusion . promptly assess the patient’s condition and immobilize
[9]
Moreover, repetitive MRI examinations can reveal distinct the patient to prevent further movement of the head
pathological changes, even in cases where the initial MRI and the entire spine, thus reducing the risk of secondary
appears normal, which is attributed to the strength of the injury [9,18,58-60] . Health-care teams must be cautious when
external forces. Notably, during the acute stage, diagnosing obtaining the medical history of SCIWORA patients.
spinal shock can be challenging. Therefore, the utilization Moreover, it is crucial to show care and attention during
of DTI and diffusion tensor tractography (DTT) may intra-hospital transfers within a single institution to
provide a more accurate diagnosis . minimize the risk of adverse events during the transfer
[43]
6. Treatment procedure [61,62] . Effective communication between
emergency services and the treatment facility is essential.
SCIWORA patients with complete neurological deficits Absolute cooperation between multiple disciplines not only
often experience poor recovery in their neurological safeguards the patient from further SCI but also expedites
function. It is essential to consider the developmental diagnosis and facilitates better treatment decisions [63-65] .
changes that children undergo and to provide appropriate
care as they mature. It is essential to consider the 6.2. Conservative treatment
developmental changes that children undergo and to provide Once the diagnosis of SCIWORA and the assessment of injury
appropriate care as they mature. Treatment for SCIWORA severity have been established, it is essential to monitor the
varies according to the patient’s MRI findings and ASIA patient’s vital signs to ensure stability. Conservative treatment,
grade . Whether surgical or non-surgical, the primary characterized by the avoidance of surgery and reliance on
[44]
objective remains the prevention of secondary injuries non-operative treatments, is always the first choice, and
and the achievement of a favorable prognosis . Surgery surgical intervention is considered the last option. However,
[45]
becomes necessary if the spine is unstable or if symptoms in emergency situations, surgical intervention may become
deteriorate during conservative treatment. The treatment necessary. Moreover, if symptoms worsen during conservative
approach for SCIWORA should be individualized, taking treatment and the patient’s stability is compromised,
into account the unique circumstances of each case . alternative treatment options must be considered. Notably,
[46]
Treatment options for SCIWORA include immobilization, some patients respond well to conservative treatment,
surgical decompression, pharmaceutical therapy, early achieving significant improvements [9,66,67] . Conversely, there
rehabilitation, preventive measures, and post-treatment are cases where conservative treatment does not yield any
care [39,47-52] . improvement [18,27,68] .
6.1. Pre-hospital aid 6.3. Pharmaceutical therapy
Appropriate and accurate pre-hospital medical attention Methylprednisolone (MP) therapy has shown potential
is critical in managing SCIWORA, as it significantly for improvement and favorable clinical outcomes in some
contributes to lowering mortality and improving cases [13,32,69-71] . However, recent studies have reported poor
overall patient prognosis. Achieving early diagnosis prognoses associated with MP treatment [25,58,72-75] . Since
and developing more effective treatment strategies 2013, the American Association of Neurosurgeons and the
for SCIWORA necessitate the close collaboration of a Congress of Neurological Surgeons guidelines no longer
multidisciplinary team of healthcare professionals . recommend the use of MP. In 2017, AOSpine recommended
[53]
Multiple medical teams, including emergency medical MP as a treatment option for patients within 8 h of acute
technicians, paramedics, orthopedic specialists, SCI. Notably, in pediatric patients with acute SCI, high-
emergency physicians, neurosurgeons, general surgeons, dose MP administered within the first 8 h failed to show
intensive care unit personnel, radiologists, neurologists, any advantages but showed an increase in incidences of
and anesthesiologists, must work in concert to address pneumonia and other complications such as osteoporosis
the complex nature of SCIWORA cases . Given the and femur head necrosis, especially in intensive care
[54]
lack of precise scientific data supporting standardized unit cases [76,77] . However, certain forms of SCIWORA
treatment protocols, therapeutic decisions should be (e.g., surfer’s myelopathy and acute hyperextension SCI)
tailored to individual patient needs and should involve a result from ischemic insults to the spinal cord, and there
multidisciplinary team of experts . The implementation is no place for the use of steroids or other drugs such as
[55]
of transfer and pre-hospital care guidelines for SCIWORA Ganglioside (GM), in the treatment of these patients.

Volume 7 Issue 1 (2024) 4 https://doi.org/10.36922/itps.1386