CC BY-NC-ND 4.0 · J Neuroanaesth Crit Care 2019; 06(03): 222-235
DOI: 10.1055/s-0039-1694686
Review Article
Indian Society of Neuroanaesthesiology and Critical Care

Critical Care Management of Acute Spinal Cord Injury—Part II: Intensive Care to Rehabilitation

Amanda Sacino
1   Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
,
Kathryn Rosenblatt
2   Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
3   Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
› Author Affiliations
Funding Kathryn Rosenblatt, MD, MHS, is supported by the Stimulating and Advancing ACCM Research (StAAR) Mentored Research Grant from the Johns Hopkins Department of Anesthesiology and Critical Care Medicine.
Further Information

Publication History

Received: 01 February 2019

Accepted after revision: 06 June 2019

Publication Date:
13 September 2019 (online)

Abstract

Spinal cord injury is devastating to those affected due to the loss of motor and sensory function, and, in some cases, cardiovascular collapse, ventilatory failure, and bowel and bladder dysfunction. Primary trauma to the spinal cord is exacerbated by secondary insult from the inflammatory response to injury. Specialized intensive care of patients with acute spinal cord injury involves the management of multiple systems and incorporates evidence-based practices to reduce secondary injury to the spinal cord. Patients greatly benefit from early multidisciplinary rehabilitation for neurologic and functional recovery. Treatment of acute spinal cord injury may soon incorporate novel molecular agents currently undergoing clinical investigation to assist in neuroprotection and neuroregeneration.

 
  • References

  • 1 Lehmann KG, Lane JG, Piepmeier JM, Batsford WP. Cardiovascular abnormalities accompanying acute spinal cord injury in humans: incidence, time course and severity. J Am Coll Cardiol 1987; 10 (01) 46-52
  • 2 Manogue M, Hirsh DS, Lloyd M. Cardiac electrophysiology of patients with spinal cord injury. Heart Rhythm 2017; 14 (06) 920-927
  • 3 Furlan JC, Fehlings MG. Cardiovascular complications after acute spinal cord injury: pathophysiology, diagnosis, and management. Neurosurg Focus 2008; 25 (05) E13
  • 4 Ditunno JF, Little JW, Tessler A, Burns AS. Spinal shock revisited: a four-phase model. Spinal Cord 2004; 42 (07) 383-395
  • 5 Atkinson PP, Atkinson JL. Spinal shock. Mayo Clin Proc 1996; 71 (04) 384-389
  • 6 Guyenet PG. The sympathetic control of blood pressure. Nat Rev Neurosci 2006; 7 (05) 335-346
  • 7 Taylor MP, Wrenn P, O'Donnell AD. Presentation of neurogenic shock within the emergency department. Emerg Med J 2017; 34 (03) 157-162
  • 8 Guly HR, Bouamra O, Lecky FE. Trauma Autabledit and Research Network. The incidence of neurogenic shock in patients with isolated spinal cord injury in the emergency department. Resuscitation 2008; 76 (01) 57-62
  • 9 Biering-Sørensen F, Biering-Sørensen T, Liu N, Malmqvist L, Wecht JM, Krassioukov A. Alterations in cardiac autonomic control in spinal cord injury. Auton Neurosci 2018; 209: 4-18
  • 10 Jones JJ. The Bainbridge reflex. J Physiol 1962; 160 (02) 298-305
  • 11 Ruiz IA, Squair JW, Phillips AA. et al. Incidence and natural progression of neurogenic shock after traumatic spinal cord injury. J Neurotrauma 2018; 35 (03) 461-466
  • 12 Inoue T, Manley GT, Patel N, Whetstone WD. Medical and surgical management after spinal cord injury: vasopressor usage, early surgerys, and complications. J Neurotrauma 2014; 31 (03) 284-291
  • 13 Altaf F, Griesdale DE, Belanger L. et al. The differential effects of norepinephrine and dopamine on cerebrospinal fluid pressure and spinal cord perfusion pressure after acute human spinal cord injury. Spinal Cord 2017; 55 (01) 33-38
  • 14 Hickey R, Albin MS, Bunegin L, Gelineau J. Autoregulation of spinal cord blood flow: is the cord a microcosm of the brain?. Stroke 1986; 17 (06) 1183-1189
  • 15 Mortazavi MM, Verma K, Harmon OA. et al. The microanatomy of spinal cord injury: a review. Clin Anat 2015; 28 (01) 27-36
  • 16 Levi L, Wolf A, Belzberg H. Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome. Neurosurgery 1993; 33 (06) 1007-1016 discussion 1016–1017
  • 17 Wolf A, Levi L, Mirvis S. et al. Operative management of bilateral facet dislocation. J Neurosurg 1991; 75 (06) 883-890
  • 18 Vale FL, Burns J, Jackson AB, Hadley MN. Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg 1997; 87 (02) 239-246
  • 19 Hawryluk G, Whetstone W, Saigal R. et al. Mean arterial blood pressure correlates with neurological recovery after human spinal cord injury: analysis of high frequency physiologic data. J Neurotrauma 2015; 32 (24) 1958-1967
  • 20 Dakson A, Brandman D, Thibault-Halman G, Christie SD. Optimization of the mean arterial pressure and timing of surgical decompression in traumatic spinal cord injury: a retrospective study. Spinal Cord 2017; 55 (11) 1033-1038
  • 21 Hadley MN, Walters BC, Grabb PA. et al. Blood pressure management after acute spinal cord injury. Neurosurgery 2002; 50 (Suppl. 03) S58-S62
  • 22 Ryken TC, Hurlbert RJ, Hadley MN. et al. The acute cardiopulmonary management of patients with cervical spinal cord injuries. Neurosurgery 2013; 72 (03) (Suppl. 02) 84-92
  • 23 Readdy WJ, Whetstone WD, Ferguson AR. et al. Complications and outcomes of vasopressor usage in acute traumatic central cord syndrome. J Neurosurg Spine 2015; 23 (05) 574-580
  • 24 Kirshblum S, Waring III W. Updates for the International Standards for Neurological Classification of Spinal Cord Injury. Phys Med Rehabil Clin N Am 2014; 25 (03) 505-517, vii
  • 25 Mathias CJ. Bradycardia and cardiac arrest during tracheal suction--mechanisms in tetraplegic patients. Eur J Intensive Care Med 1976; 2 (04) 147-156
  • 26 van Lieshout JJ, Imholz BP, Wesseling KH, Speelman JD, Wieling W. Singing-induced hypotension: a complication of a high spinal cord lesion. Neth J Med 1991; 38 (01) (02) 75-79
  • 27 Eldahan KC, Rabchevsky AG. Autonomic dysreflexia after spinal cord injury: systemic pathophysiology and methods of management. Auton Neurosci 2018; 209: 59-70
  • 28 Krassioukov AV, Furlan JC, Fehlings MG. Autonomic dysreflexia in acute spinal cord injury: an under-recognized clinical entity. J Neurotrauma 2003; 20 (08) 707-716
  • 29 McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ. Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil 1999; 80 (11) 1402-1410
  • 30 Alexander MS, Biering-Sorensen F, Bodner D. et al. International standards to document remaining autonomic function after spinal cord injury. Spinal Cord 2009; 47 (01) 36-43
  • 31 Caruso D, Gater D, Harnish C. Prevention of recurrent autonomic dysreflexia: a survey of current practice. Clin Auton Res 2015; 25 (05) 293-300
  • 32 Slack RS, Shucart W. Respiratory dysfunction associated with traumatic injury to the central nervous system. Clin Chest Med 1994; 15 (04) 739-749
  • 33 Dicpinigaitis PV, Spungen AM, Bauman WA, Absgarten A, Almenoff PL. Bronchial hyperresponsiveness after cervical spinal cord injury. Chest 1994; 105 (04) 1073-1076
  • 34 Grossman RG, Frankowski RF, Burau KD. et al. Incidence and severity of acute complications after spinal cord injury. J Neurosurg Spine 2012; 17 (01) Suppl): 119-128
  • 35 Bhaskar KR, Brown R, O'Sullivan DD, Melia S, Duggan M, Reid L. Bronchial mucus hypersecretion in acute quadriplegia. Macromolecular yields and glycoconjugate composition. Am Rev Respir Dis 1991; 143 (03) 640-648
  • 36 Consortium for Spinal Cord Medicine. Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med 2008; 31 (04) 403-479
  • 37 Leelapattana P, Fleming JC, Gurr KR, Bailey SI, Parry N, Bailey CS. Predicting the need for tracheostomy in patients with cervical spinal cord injury. J Trauma Acute Care Surg 2012; 73 (04) 880-884
  • 38 Lee DS, Park CM, Carriere KC, Ahn J. Classification and regression tree model for predicting tracheostomy in patients with traumatic cervical spinal cord injury. Eur Spine J 2017; 26 (09) 2333-2339
  • 39 Tanaka J, Yugue I, Shiba K, Maeyama A, Naito M. A study of risk factors for tracheostomy in patients with a cervical spinal cord injury. Spine 2016; 41 (09) 764-771
  • 40 Beom JY, Seo HY. The need for early tracheostomy in patients with traumatic cervical cord injury. Clin Orthop Surg 2018; 10 (02) 191-196
  • 41 Wang Y, Guo Z, Fan D. et al. A meta-analysis of the influencing factors for tracheostomy after cervical spinal cord injury. BioMed Res Int 2018; 2018: 5895830
  • 42 Galeiras R, Mourelo M, Bouza MT. et al. Risk analysis based on the timing of tracheostomy procedures in patients with spinal cord injury requiring cervical spine surgery. World Neurosurg 2018; 116: e655-e661
  • 43 Lozano CP, Chen KA, Marks JA, Jenoff JS, Cohen MJ, Weinstein MS. Safety of early tracheostomy in trauma patients after anterior cervical fusion. J Trauma Acute Care Surg 2018; 85 (04) 741-746
  • 44 Romero J, Vari A, Gambarrutta C, Oliviero A. Tracheostomy timing in traumatic spinal cord injury. Eur Spine J 2009; 18 (10) 1452-1457
  • 45 Guirgis AH, Menon VK, Suri N. et al. Early versus late tracheostomy for patients with high and low cervical spinal cord injuries. Sultan Qaboos Univ Med J 2016; 16 (04) e458-e463
  • 46 Kim WY, Suh HJ, Hong SB, Koh Y, Lim CM. Diaphragm dysfunction assessed by ultrasonography: influence on weaning from mechanical ventilation. Crit Care Med 2011; 39 (12) 2627-2630
  • 47 Vázquez RG, Sedes PR, Fariña MM, Marqués AM, Velasco MEF. Respiratory management in the patient with spinal cord injury. Biomed Res Int 2013; 2013: 168757
  • 48 Fayssoil A, Behin A, Ogna A. et al. Diaphragm: pathophysiology and ultrasound imaging in neuromuscular disorders. J Neuromuscul Dis 2018; 5 (01) 1-10
  • 49 Weber CD, Lefering R, Kobbe P. et al; Trauma Register DGU. Blunt cerebrovascular artery injury and stroke in severely injured patients: an international multicenter analysis. World J Surg 2018; 42 (07) 2043-2053
  • 50 Schicho A, Luerken L, Meier R. et al. Incidence of traumatic carotid and vertebral artery dissections: results of cervical vessel computed tomography angiogram as a mandatory scan component in severely injured patients. Ther Clin Risk Manag 2018; 14: 173-178
  • 51 Stein DM, Boswell S, Sliker CW, Lui FY, Scalea TM. Blunt cerebrovascular injuries: does treatment always matter?. J Trauma 2009; 66 (01) 132-143 discussion 143–144
  • 52 Fleck SK, Langner S, Baldauf J, Kirsch M, Kohlmann T, Schroeder HWS. Incidence of blunt craniocervical artery injuries: use of whole-body computed tomography trauma imaging with adapted computed tomography angiography. Neurosurgery 2011; 69 (03) 615-623 discussion 623–624
  • 53 Biffl WL, Moore EE, Offner PJ. et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg 1999; 178 (06) 517-522
  • 54 Anto VP, Brown JB, Peitzman AB. et al. Blunt cerebrovascular injury in elderly fall patients: are we screening enough?. World J Emerg Surg 2018; 13: 30
  • 55 Foreman PM, Harrigan MR. Blunt traumatic extracranial cerebrovascular injury and ischemic stroke. Cerebrovasc Dis Extra 2017; 7 (01) 72-83
  • 56 Brommeland T, Helseth E, Aarhus M. et al. Best practice guidelines for blunt cerebrovascular injury (BCVI). Scand J Trauma Resusc Emerg Med 2018; 26 (01) 90
  • 57 Geddes AE, Burlew CC, Wagenaar AE. et al. Expanded screening criteria for blunt cerebrovascular injury: a bigger impact than anticipated. Am J Surg 2016; 212 (06) 1167-1174
  • 58 Bromberg WJ, Collier BC, Diebel LN. et al. Blunt cerebrovascular injury practice management guidelines: the Eastern Association for the Surgery of Trauma. J Trauma 2010; 68 (02) 471-477
  • 59 Shafafy R, Suresh S, Afolayan JO, Vaccaro AR, Panchmatia JR. Blunt vertebral vascular injury in trauma patients: ATLS® recommendations and review of current evidence. J Spine Surg 2017; 3 (02) 217-225
  • 60 Anaya C, Munera F, Bloomer CW, Danton GH, Caban K. Screening multidetector computed tomography angiography in the evaluation on blunt neck injuries: an evidence-based approach. Semin Ultrasound CT MR 2009; 30 (03) 205-214
  • 61 Cothren CC, Moore EE, Ray Jr CE, Johnson JL, Moore JB, Burch JM. Cervical spine fracture patterns mandating screening to rule out blunt cerebrovascular injury. Surgery 2007; 141 (01) 76-82
  • 62 Burlew CC, Sumislawski JJ, Behnfield CD. et al. Time to stroke: A Western Trauma Association multicenter study of blunt cerebrovascular injuries. J Trauma Acute Care Surg 2018; 85 (05) 858-866
  • 63 Krajewski LP, Hertzer NR. Blunt carotid artery trauma: report of two cases and review of the literature. Ann Surg 1980; 191 (03) 341-346
  • 64 Mokri B, Piepgras DG, Houser OW. Traumatic dissections of the extracranial internal carotid artery. J Neurosurg 1988; 68 (02) 189-197
  • 65 Cothren CC, Moore EE, Ray Jr CE. et al. Screening for blunt cerebrovascular injuries is cost-effective. Am J Surg 2005; 190 (06) 845-849
  • 66 Biffl WL, Moore EE, Offner PJ, Brega KE, Franciose RJ, Burch JM. Blunt carotid arterial injuries: implications of a new grading scale. J Trauma 1999; 47 (05) 845-853
  • 67 Foreman PM, Griessenauer CJ, Kicielinski KP. et al. Reliability assessment of the Biffl Scale for blunt traumatic cerebrovascular injury as detected on computer tomography angiography. J Neurosurg 2017; 127 (01) 32-35
  • 68 Cothren CC, Biffl WL, Moore EE, Kashuk JL, Johnson JL. Treatment for blunt cerebrovascular injuries: equivalence of anticoagulation and antiplatelet agents. Arch Surg 2009; 144 (07) 685-690
  • 69 Shahan CP, Magnotti LJ, McBeth PB, Weinberg JA, Croce MA, Fabian TC. Early antithrombotic therapy is safe and effective in patients with blunt cerebrovascular injury and solid organ injury or traumatic brain injury. J Trauma Acute Care Surg 2016; 81 (01) 173-177
  • 70 Callcut RA, Hanseman DJ, Solan PD. et al. Early treatment of blunt cerebrovascular injury with concomitant hemorrhagic neurologic injury is safe and effective. J Trauma Acute Care Surg 2012; 72 (02) 338-345 ,discussion345–346
  • 71 McNutt MK, Kale AC, Kitagawa RS. et al. Management of blunt cerebrovascular injury (BCVI) in the multisystem injury patient with contraindications to immediate anti-thrombotic therapy. Injury 2018; 49 (01) 67-74
  • 72 Jindal G, Fortes M, Miller T, Scalea T, Gandhi D. Endovascular stent repair of traumatic cervical internal carotid artery injuries. J Trauma Acute Care Surg 2013; 75 (05) 896-903
  • 73 Edwards NM, Fabian TC, Claridge JA, Timmons SD, Fischer PE, Croce MA. Antithrombotic therapy and endovascular stents are effective treatment for blunt carotid injuries: results from longtermfollowup. J Am Coll Surg 2007; 204 (05) 1007-1013 discussion1014–1015
  • 74 Shahan CP, Sharpe JP, Stickley SM. et al. The changing role of endovascular stenting for blunt cerebrovascular injuries. J Trauma Acute Care Surg 2018; 84 (02) 308-311
  • 75 Biffl WL, Ray Jr CE, Moore EE. et al. Treatment-related outcomes from blunt cerebrovascular injuries: importance of routine follow-up arteriography. Ann Surg 2002; 235 (05) 699-706 discussion706–707
  • 76 Spanos K, Karathanos C, Stamoulis K, Giannoukas AD. Endovascular treatment of traumatic internal carotid artery pseudoaneurysm. Injury 2016; 47 (02) 307-312
  • 77 Mei Q, Sui M, Xiao W. et al. Individualized endovascular treatment of high-grade traumatic vertebral artery injury. Acta Neurochir (Wien) 2014; 156 (09) 1781-1788
  • 78 Garg K, Rockman CB, Lee V. et al. Presentation and management of carotid artery aneurysms and pseudoaneurysms. J Vasc Surg 2012; 55 (06) 1618-1622
  • 79 Cogbill TH, Moore EE, Meissner M. et al. The spectrum of blunt injury to the carotid artery: a multicenter perspective. J Trauma 1994; 37 (03) 473-479
  • 80 Lauerman MH, Feeney T, Sliker CW. et al. Lethal now or lethal later: the natural history of Grade 4 blunt cerebrovascular injury. J Trauma Acute Care Surg 2015; 78 (06) 1071-1074 discussion1074–1075
  • 81 Chung WS, Lin CL, Chang SN, Chung HA, Sung FC, Kao CH. Increased risk of deep vein thrombosis and pulmonary thromboembolism in patients with spinal cord injury: a nationwide cohort prospective study. Thromb Res 2014; 133 (04) 579-584
  • 82 Prevention of Venous Thromboembolism in Individuals with Spinal Cord Injury: Clinical Practice Guidelines for Health Care Providers. 3rd ed. Consortium for Spinal Cord Medicine. Top Spinal Cord Inj Rehabil. 2016; 22 (03) 209-240
  • 83 Chung EA, Emmanuel AV. Gastrointestinal symptoms related to autonomic dysfunction following spinal cord injury. Prog Brain Res 2006; 152: 317-333
  • 84 Sarıfakıoğlu B, Afşar SI, Yalbuzdağ ŞA, Ustaömer K, Ayaş Ş. Acute abdominal emergencies and spinal cord injury; our experiences: a retrospective clinical study. Spinal Cord 2014; 52 (09) 697-700
  • 85 Segal JL, Milne N, Brunnemann SR, Lyons KP. Metoclopramide-induced normalization of impaired gastric emptying in spinal cord injury. Am J Gastroenterol 1987; 82 (11) 1143-1148
  • 86 Clanton Jr LJ, Bender J. Refractory spinal cord injury induced gastroparesis: resolution with erythromycin lactobionate, a case report. J Spinal Cord Med 1999; 22 (04) 236-238
  • 87 Garcia-Arguello LY, O'Horo JC, Farrell A. et al. Infections in the spinal cord-injured population: a systematic review. Spinal Cord 2017; 55 (06) 526-534
  • 88 Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord 2012; 50 (05) 365-372
  • 89 DeVivo MJ. Sir Ludwig Guttmann Lecture: trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973-2006. Spinal Cord 2007; 45 (11) 713-721
  • 90 Handrakis JP, Trbovich M, Hagen EM, Price M. Thermodysregulation in persons with spinal cord injury: case series on use of the autonomic standards. Spinal Cord Ser Cases 2017; 3: 17086
  • 91 Khan S, Plummer M, Martinez-Arizala A, Banovac K. Hypothermia in patients with chronic spinal cord injury. J Spinal Cord Med 2007; 30 (01) 27-30
  • 92 Biering-Sørensen F, Alexander MS, van Asbeck FWA, Donovan W, Krassioukov A, Post MWM. Version 1.1 of the international spinal cord injury skin and thermoregulation function basic data set. Spinal Cord 2017; 55 (06) 566-569
  • 93 Bracken MB, Collins WF, Freeman DF. et al. Efficacy of methylprednisolone in acute spinal cord injury. JAMA 1984; 251 (01) 45-52
  • 94 Bracken MB, Shepard MJ, Collins WF. et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 1990; 322 (20) 1405-1411
  • 95 Bracken MB, Holford TR. Effects of timing of methylprednisolone or naloxone administration on recovery of segmental and long-tract neurological function in NASCIS 2. J Neurosurg 1993; 79 (04) 500-507
  • 96 Bracken MB, Shepard MJ, Holford TR. et al. Administration of methylprednisolone for 24 or 48 hours or tirilazadmesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA 1997; 277 (20) 1597-1604
  • 97 Nesathurai S. Steroids and spinal cord injury: revisiting the NASCIS 2 and NASCIS 3 trials. J Trauma 1998; 45 (06) 1088-1093
  • 98 Chikuda H, Yasunaga H, Takeshita K. et al. Mortality and morbidity after high-dose methylprednisolone treatment in patients with acute cervical spinal cord injury: a propensity-matched analysis using a nationwide administrative database. Emerg Med J 2014; 31 (03) 201-206
  • 99 Evaniew N, Noonan VK, Fallah N. et al; RHSCIR Network. Methylprednisolone for the treatment of patients with acute spinal cord injuries: a propensity score-matched cohort study from a Canadian multi-center spinal cord injury registry. J Neurotrauma 2015; 32 (21) 1674-1683
  • 100 Hurlbert RJ, Hadley MN, Walters BC. et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery 2013; 72 (03) (Suppl. 02) 93-105
  • 101 Dharmadasa T, Kiernan MC. Riluzole, disease stage and survival in ALS. Lancet Neurol 2018; 17 (05) 385-386
  • 102 Grossman RG, Fehlings MG, Frankowski RF. et al. A prospective, multicenter, phase I matched-comparison group trial of safety, pharmacokinetics, and preliminary efficacy of riluzole in patients with traumatic spinal cord injury. J Neurotrauma 2014; 31 (03) 239-255
  • 103 Fehlings MG, Nakashima H, Nagoshi N, Chow DSL, Grossman RG, Kopjar B. Rationale, design and critical end points for the Riluzole in Acute Spinal Cord Injury Study (RISCIS): a randomized, double-blinded, placebo-controlled parallel multi-center trial. Spinal Cord 2016; 54 (01) 8-15
  • 104 ClinicalTrials.gov Riluzole in Spinal Cord Injury Study. Available at: https://clinicaltrials.gov/ct2/show/NCT01597518 Accessed May 2019
  • 105 Wells JE, Hurlbert RJ, Fehlings MG, Yong VW. Neuroprotection by minocycline facilitates significant recovery from spinal cord injury in mice. Brain 2003; 126 (Pt 7): 1628-1637
  • 106 Casha S, Zygun D, McGowan MD, Bains I, Yong VW, Hurlbert RJ. Results of a phase II placebo-controlled randomized trial of minocycline in acute spinal cord injury. Brain 2012; 135 (Pt 4): 1224-1236
  • 107 ClinicalTrials.gov Minocycline in Acute Spinal Cord Injury (MASC). Available at: https://clinicaltrials.gov/ct2/show/NCT01828203 Accessed April 2019
  • 108 Wang J, Pearse DD. Therapeutic hypothermia in spinal cord injury: the status of its use and open questions. Int J Mol Sci 2015; 16 (08) 16848-16879
  • 109 ClinicalTrials.gov Systemic Hypothermia in Acute Cervical Spinal Cord Injury. Available at: https://clinicaltrials.gov/ct2/show/NCT02991690 Accessed April 2019
  • 110 Sandrow-Feinberg HR, Houlé JD. Exercise after spinal cord injury as an agent for neuroprotection, regeneration and rehabilitation. Brain Res 2015; 1619: 12-21
  • 111 Rozeboom N, Parenteau K, Carratturo D. Rehabilitation starts in the intensive care unit. Crit Care Nurs Q 2012; 35 (03) 234-240
  • 112 Burke D, Fullen BM, Stokes D, Lennon O. Neuropathic pain prevalence following spinal cord injury: a systematic review and meta-analysis. Eur J Pain 2017; 21 (01) 29-44
  • 113 Finnerup NB, Norrbrink C, Trok K. et al. Phenotypes and predictors of pain following traumatic spinal cord injury: a prospective study. J Pain 2014; 15 (01) 40-48
  • 114 Williams R, Murray A. Prevalence of depression after spinal cord injury: a meta-analysis. Arch Phys Med Rehabil 2015; 96 (01) 133-140
  • 115 Müller R, Landmann G, Béchir M. et al. Chronic pain, depression and quality of life in individuals with spinal cord injury: mediating role of participation. J Rehabil Med 2017; 49 (06) 489-496
  • 116 Widerström-Noga E. Neuropathic pain and spinal cord injury: phenotypes and pharmacological management. Drugs 2017; 77 (09) 967-984
  • 117 Guy SD, Mehta S, Harvey D. et al. The CanPain SCI Clinical Practice Guideline for Rehabilitation Management of Neuropathic Pain after Spinal Cord: recommendations for model systems of care. Spinal Cord 2016; 54 (Suppl. 01) S24-S27
  • 118 Finnerup NB. Neuropathic pain and spasticity: intricate consequences of spinal cord injury. Spinal Cord 2017; 55 (12) 1046-1050
  • 119 Holtz KA, Szefer E, Noonan VK, Kwon BK, Mills PB. Treatment patterns of in-patient spasticity medication use after traumatic spinal cord injury: a prospective cohort study. Spinal Cord 2018; 56 (12) 1176-1183
  • 120 Marciniak C, Rader L, Gagnon C. The use of botulinum toxin for spasticity after spinal cord injury. Am J Phys Med Rehabil 2008; 87 (04) 312-317 ,quiz 318–320, 329
  • 121 D'Amico JM, Condliffe EG, Martins KJ, Bennett DJ, Gorassini MA. Recovery of neuronal and network excitability after spinal cord injury and implications for spasticity. Front Integr Nuerosci 2014; 8: 36
  • 122 Wilson JR, Cadotte DW, Fehlings MG. Clinical predictors of neurological outcome, functional status, and survival after traumatic spinal cord injury: a systematic review. J Neurosurg Spine 2012; 17 (01) Suppl): 11-26
  • 123 Ahuja CS, Fehlings M. Concise review: bridging the gap: novel neuroregenerative and neuroprotective strategies in spinal cord injury. Stem Cells Transl Med 2016; 5 (07) 914-924
  • 124 Levinson B, Lee J, Chou H, Maiman D. SUN13837 in treatment of acute spinal cord injury, the ASCENT-ASCI Study. ClinNeurolNeurosc 2017; 2 (01) 1
  • 125 Dubreuil CI, Winton MJ, McKerracher L. Rho activation patterns after spinal cord injury and the role of activated Rho in apoptosis in the central nervous system. J Cell Biol 2003; 162 (02) 233-243
  • 126 Fehlings MG, Theodore N, Harrop J. et al. A phase I/IIa clinical trial of a recombinant Rho protein antagonist in acute spinal cord injury. J Neurotrauma 2011; 28 (05) 787-796
  • 127 Fehlings MG, Kim KD, Aarabi B. et al. Rho inhibitor VX-210 in acute traumatic subaxial cervical spinal cord injury: design of the SPinal Cord Injury Rho INhibitionInvestiGation (SPRING) clinical trial. J Neurotrauma 2018; 35 (09) 1049-1056
  • 128 Anderson KD, Guest JD, Dietrich WD. et al. Safety of autologous human schwann cell transplantation in subacute thoracic spinal cord injury. J Neurotrauma 2017; 34 (21) 2950-2963
  • 129 ClinicalTrials.gov The Safety of ahSC in Chronic SCI with Rehabilitation. Available at; https://clinicaltrials.gov/ct2/show/NCT02354625 Accessed May 2019
  • 130 Dose Escalation Study of AST-OPC1 in Spinal Cord Injury. Available at: https://clinicaltrials.gov/ct2/show/NCT02302157 Accessed May 2019
  • 131 Watzlawick R, Rind J, Sena ES. et al. Olfactory ensheathing cell transplantation in experimental spinal cord injury: effect size and reporting bias of 62 experimental treatments: a systematic review and meta-analysis. PLoS Biol 2016; 14 (05) e1002468
  • 132 Study of Human Central Nervous System (CNS) Stem Cell Transplantation in Cervical Spinal Cord Injury. Available at: https://clinicaltrials.gov/ct2/show/NCT02163876 Accessed May 2019
  • 133 ClinicalTrials.gov Safety and Efficacy of Autologous Mesenchymal Stem Cells in Chronic Spinal Cord Injury. Available at: https://clinicaltrials.gov/ct2/show/NCT01676441 Accessed May 2019
  • 134 Theodore N, Hlubek R, Danielson J. et al. First human implantation of a bioresorbable polymer scaffold for acute traumatic spinal cord injury: a clinical pilot study for safety and feasibility. Neurosurgery 2016; 79 (02) E305-E312
  • 135 ClinicalTrials.gov Functional Neural Regeneration Collagen Scaffold Transplantation in Acute Spinal Cord Injury Patients. Available at: https://clinicaltrials.gov/ct2/show/NCT02510365 Accessed May 2019
  • 136 ClinicalTrials.gov Cerebrospinal Fluid Drainage (CSFD) in Acute Spinal Cord Injury. Available at: https://clinicaltrials.gov/ct2/show/NCT02495545 Accessed May 2019
  • 137 Chanques G, Viel E, Constantin JM. et al. The measurement of pain in intensive care unit: comparison of 5 self-report intensity scales: Pain 2010; 151 (03) 711-721
  • 138 Devlin JW, Skrobik Y, Gélinas C. et al. Clinical practice guidelines for the prevention and management of pain, agitation/sedation, delirium, immobility, and sleep disruption in adult patients in the ICU. Crit Care Med 2018; 46 (09) e825-e873
  • 139 Gélinas C, Puntillo KA, Levin P, Azoulay E. The behavior pain assessment tool for critically ill adults: a validation study in 28 countries. Pain 2017; 158 (05) 811-821
  • 140 Guy SD, Mehta S, Casalino A. et al. The CanPain SCI clinical practice guidelines for rehabilitation management of neuropathic pain after spinal cord: recommendations for treatment. Spinal Cord 2016; 54 (S1): S14-S23