The first approach to treatment of a spinal cord injury is to minimize the ongoing damage to the spinal cord. This requires relieving pressure on the spinal cord and optimizing blood flow.

Several medications are now used to minimize the amount of spinal cord degeneration soon after injury. Methylprednisolone, a synthetic steroid hormone related to cortisone, is at the top of this list. When given immediately after the injury, methylprednisolone reduces the amount of damage to the nerve cells of the cord. Although this drug cannot reverse he damage already done, it can minimize the ongoing damage and result in better spinal cord function. How methylprednisolone works is not known, but it may interfere with the action of the toxic chemicals released by damaged cells. One limitation of this approach is that methylprednisolone must be administered very soon after the injury to produce any beneficial effect. Once a few hours have passed, the damage is already done and the drug is useless.

Methylprednisolone treatment is now in widespread use around the world. It results in a small but significant improvement in recovery from spinal cord injury. For example, a patient who might have had a completely paralyzed hand without methylprednisolone treatment may instead have a weak but functional hand. Thousands of patients have benefited from this drug, and its use has been an important breakthrough in the treatment of spinal cord injury. A number of other drugs with a similar function are currently under development. Some, such as Sygen, are already being tested.

Surgery on the spine can have a similar beneficial effect. By removing foreign bodies or abnormal structures that are pressing on the spinal cord, surgeons can sometimes restore normal cord anatomy and blood supply before permanent damage is done. New techniques are currently under development to improve surgical outcomes and reduce the complications of spinal surgery, which can be serious.

Another area of research is the development of medications to reduce demyelination after a spinal cord injury. As noted above, demyelination impairs nerve impulse conduction, even in nerve fibers that are otherwise intact. Reducing the extent of demyelination by medical treatment should result in better functions of the nerve fibers.

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NSAIDs and some of the rheumatoid arthritis drugs relieve symptoms but do not change the overall progression of the disease. As an analogy, consider a house that is “suffering” from termites. You could delay the house falling down by removing heavy furniture, tiptoeing about, and putting large beams under the joists; however, none of these methods would do anything to stop the gradual destruction of your house. Eventually, the termites would cause enough irreversible damage, and your house would collapse.

These delaying tactics are like NSAIDs. They treat the symptoms, but they don’t address the underlying cause.

In the case of the termites, a more definitive approach would be to hire an exterminator to kill them. In medical terms, this would be described as a “disease-modifying” treatment.

The DMARD drugs act more like this approach. They reach deeply into rheumatoid arthritis and affect it closer to its root.

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