title: Management strategies for acute spinal cord injury:  current options and future perspectives.
abstract: OBJECTIVE
  Spinal cord injury is a devastating acute neurological condition with loss of function and poor long-term prognosis. This review summarizes current management strategies and innovative concepts on the horizon.
  
  
  RESULTS
  The routine use of steroids in patients with spinal cord injuries has been largely abandoned and considered a 'harmful standard of care'. Prospective trials have shown that early spine stabilization within 24  h results in decreased secondary complication rates. Neuronal plasticity and axonal regeneration in the adult spinal cord are limited due to myelin-associated inhibitory molecules, such as Nogo-A. The experimental inhibition of Nogo-A ameliorates axonal sprouting and functional recovery in animal models.
  
  
  CONCLUSIONS
  General management strategies for acute spinal cord injury consist of protection of airway, breathing, oxygenation and control of blood loss with maintenance of blood pressure. Unstable spine fractures should be stabilized early to allow unrestricted mobilization of patients with spinal cord injuries and to decrease preventable complications. Steroids are largely considered obsolete and have been abandoned in clinical guidelines. Nogo-A represents a promising new pharmacological target to promote sprouting of injured axons and restore function. Prospective clinical trials of Nogo-A inhibition in patients with spinal cord injuries are currently under way.
authors.affiliation: Department of Orthopaedic Surgery, Denver Health Medical Center, University of Colorado, School of Medicine, Denver, CO 80204, USA. philip.stahel@dhha.org
authors.forename: Philip F
authors.initials: PF
authors.lastname: Stahel
authors.forename: Todd
authors.initials: T
authors.lastname: VanderHeiden
authors.forename: Michael A
authors.initials: MA
authors.lastname: Finn
mesh_terms: D002490:Central Nervous System / Q000276:immunology; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006131:Growth Inhibitors / Q000627:therapeutic use; D006801:Humans; D007036:Hypothermia, Induced; D007103:Immobilization; D008297:Male; D009185:Myelin Proteins / Q000627:therapeutic use; D000070798:Nogo Proteins; D047492:Peroxisome Proliferator-Activated Receptors / Q000627:therapeutic use; D013119:Spinal Cord Injuries / Q000145:classification / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D013256:Steroids / Q000627:therapeutic use; D014481:United States
chemical_list: D006131:Growth Inhibitors; D009185:Myelin Proteins; D000070798:Nogo Proteins; D047492:Peroxisome Proliferator-Activated Receptors; C000603199:RTN4 protein, human; D013256:Steroids