PHARMACOLOGICAL AND SURGICAL INTERVENTIONS IN TRAUMATIC SPINAL CORD INJURIES

Abstract

Traumatic spinal cord injury (TSI) is a serious neurological condition associated with motor, sensory, and autonomic deficits, with a significant impact on functionality and quality of life. In addition to primary mechanical damage, TSI triggers a cascade of secondary pathophysiological events, including edema, vascular dysfunction, excitotoxicity, and neuroinflammation, which contribute to injury progression and variability in clinical outcomes. In this context, early therapeutic strategies and adequate monitoring of natural recovery are fundamental for preserving viable neural tissue and optimizing functional prognosis. The objective of this study was to synthesize recent scientific evidence regarding surgical, pharmacological, and emerging interventions in the management of traumatic spinal cord injury, as well as to understand the patterns of neurological recovery and the role of imaging monitoring. This is a narrative literature review, conducted in the PubMed database, using the descriptors Traumatic Spinal Cord Injuries, Therapy, and Diagnosis, combined with Boolean operators AND and OR, according to MeSH terminology. Articles published in the last five years, in English, with full text access and a direct focus on the therapeutic management of musculoskeletal disorders (MSDs), prioritizing randomized clinical trials and systematic reviews, were included. The results demonstrate that early surgical decompression, preferably within the first 24 hours after trauma, is associated with better neurological outcomes, regardless of the severity or location of the lesion, in addition to reducing complications related to prolonged immobility. In the pharmacological field, agents such as riluzole showed an adequate safety profile, but without a statistically significant benefit in the primary motor outcome, while the use of high-dose methylprednisolone is currently discouraged due to the lack of proven efficacy and the high risk of adverse effects. Emerging therapies, such as the use of mesenchymal stem cells and non-invasive neuromodulation techniques, have demonstrated safety and potential functional benefit in initial studies, especially in incomplete lesions. It was also observed that spontaneous neurological recovery occurs predominantly in the first six to nine months after trauma, being most intense in the first three months, with greater potential in patients with incomplete lesions. Magnetic resonance imaging, especially in multiparametric approaches, proved essential for evolutionary monitoring, prognostic stratification, and differentiation between natural recovery and therapeutic effects. It is concluded that the management of traumatic spinal cord injury should integrate early surgical interventions, caution in the use of traditional pharmacological therapies, progressive incorporation of regenerative and neuromodulatory strategies, as well as clinical and imaging follow-up, aiming for an individualized and evidence-based approach to maximize functional recovery.