Spinal Cord Injury
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Spring 1998
Volume 9, Number 1
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 Contents of this Issue
From the Guest Editor
John H. McVicker, MD
Recovery of Neurologic Function in
Spinal Cord Injury: A Review of New and Experimental Therapies
Daniel P. Lammertse, MD
Over the past several decades,
progress in basic research has yielded a more complete
understanding of the pathophysiology of acute and chronic
spinal cord injury (SCI). This has led to clinical trials
in a number of acute treatments and the widespread
application of one such treatment, methylprednisolone,
for human SCI. Research in chronic restorative therapies
is progressing and will hopefully yield beneficial
treatments in the future. Rehabilitation should progress
to facilitate patient education and enable incorporation
of emerging therapies as they achieve clinical
applicability.
Progressive Posttraumatic Myelopathies
Scott P. Falci, MD
Progressive neurologic deterioration
following spinal cord injury unrelated to anatomical
compression of the spinal cord or spinal instability has
become more widely recognized. Cystic myelopathy or
posttraumatic syringomyelia as a cause of progressive
neurologic deterioration has been well described. One
sees a spinal cord cyst develop at the injury site, which
may progressively ascend and/or descend with time.
Clinically, progressive loss of sensation and strength,
as well as worsening spasticity, pain, hyperhidrosis,
autonomic dysreflexia, and a Horner’s Syndrome, may
occur.
Primary Care for Individuals with
Spinal Cord Injury
Kelly Johnson, MSN, RN, Daniel P. Lammertse, MD
Individuals with spinal cord injury
(SCI) need a variety of health care services throughout
their lifetime. Necessary health care services include
disability management related to ongoing monitoring and
treatment of their related health issues, basic primary
care including health promotion, disease prevention, and
management of a variety of health and disease states they
may face. With an increasing number of individuals with
SCI being enrolled in managed health care plans, it is
essential that primary care providers become familiar
with the health care needs of this population. This
article attempts to focus the reader’s attention on
current therapeutic options.
Aging with Spinal Cord Injury
Robert R. Menter, MD
Spinal Cord Injury (SCI) has been
transformed from an injury with nearly certain death
shortly after injury to a disability in which nearly all
people survive the injury process and then go on to
active, productive lives. With established survival
following SCI we now face the issue of many individuals
growing older with SCI, adding to the normal aging
process. Education and development of interventions can
be used to modify the aging process and hopefully delay
the onset of decline.
Management of Chronic Pain in Spinal
Cord Injury
Thomas E. Balazy, MD
As medical progress has given spinal
cord injured individuals improved health and life
expectancy, chronic pain has emerged for some as a
significant challenge and the most difficult aspect with
which they must cope. Chronic pain is central neuropathic
pain that requires centrally-directed treatment. This
review summarizes the treatment options available that
begin with conservative medical and physical therapy then
progresses to neuroablative procedures, and finally
narcotics as warranted. Usually no single treatment is
efficacious and instead an eclectic program is needed.
Multiple treatments require a team of multi-disciplined
professionals to provide the appropriate combination of
ongoing care that can reduce the hurt of chronic spinal
cord injury pain.
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