Spinal cord injury

The annual incidence of acute spinal cord injury in the UK is 15-40 cases per million. More than half these injuries are the result of road traffic accidents, with falls, industrial accidents, sports or violence making up most of the remainder. Violent injury accounts for only a small percentage of cases in this country. The typical patient is male (male to female ratio is 4: 1) and young (peak incidence is at 20-40 years). The initial mechanical trauma leads to injury of the neural elements, this is the primary injury. Blood vessels are damaged, axons disrupted and neural cell membranes broken. The spinal cord swells and is compressed in the spinal canal. Ischaemia occurs when the cord swelling exceeds venous blood pressure. This leads to failure of autoregulation of blood flow. The ischaemia leads to a release of toxins from neural cells triggering a secondary injury. The main goal in the management of spinal cord injuries is to prevent secondary injury.