This 2001 narrative review by Sekhon and Fehlings synthesizes population-level data on the incidence, demographics, injury patterns, and economic burden of acute SCI, then surveys the pathophysiology of primary and secondary injury mechanisms — from vascular ischemia and ionic derangements to free radical cascades and oligodendrocyte apoptosis.
When evaluating any acute SCI, cervical level and neurologic grade are the dominant prognostic variables — C1–C3 injuries carry more than 6× the mortality of paraplegia, and converting a complete to an incomplete injury (even ASIA B) meaningfully changes prognosis.
The 8-hour methylprednisolone window and the biological rationale for avoiding hypotension and hypoxia both stem directly from the secondary injury cascade described here.
This 2001 narrative review by Sekhon and Fehlings synthesizes population-level data on the incidence, demographics, injury patterns, and economic burden of acute SCI, then surveys the pathophysiology of primary and secondary injury mechanisms — from vascular ischemia and ionic derangements to free radical cascades and oligodendrocyte apoptosis.
When evaluating any acute SCI, cervical level and neurologic grade are the dominant prognostic variables — C1–C3 injuries carry more than 6× the mortality of paraplegia, and converting a complete to an incomplete injury (even ASIA B) meaningfully changes prognosis.
The 8-hour methylprednisolone window and the biological rationale for avoiding hypotension and hypoxia both stem directly from the secondary injury cascade described here.