Damage to the spinal cord is the result of two types of injury. First is the direct mechanical injury from traumatic impact. This insult sets into motion a series of vascular and chemical processes that lead to secondary injury. The initial phase is characterized by hemorrhage into the cord and formation of edema at the injured site and surrounding region. Local spinal cord blood flow is diminished owing to vasospasm and thrombosis of the small arterioles within the gray and white matter. Extension of edema may further compromise blood flow and increase ischemia. A secondary tissue degeneration phase begins within hours of injury. This is associated with the release of membrane-destabilizing enzymes, mediators of inflammation, and disturbance of electrophysiologic coupling by disruption of calcium channel pathways. Lipid peroxidation and hydrolysis appear to play a major role in this secondary phase of spinal cord injury. 6
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