Therapeutic strategies that modulate the acute phase of secondary spinal cord injury scarring and inflammation and improve injury outcomes.

Introduction: The acute phase of secondary spinal cord injury (SCI) is a crucial therapeutic window to mitigate ongoing damage and promote tissue repair. The present systematic review critically evaluates the efficacy and safety of current management modalities for this phase, identifying gaps in knowledge and providing insights for future research directions.

Methods: In December 2024, PubMed, Web of Science, Google Scholar, and Embase were accessed with no time constraints. All the clinical studies investigating the pharmacological management of secondary SCI were accessed.

Results: Data from 3017 patients (385 women) were collected. The mean length of the follow-up was 6 ± 3.4 months, and the mean age of the patients was 43.3 ± 10.3 years.

Conclusion: Erythropoietin (EPO) improves motor function, reduces impairment in secondary spinal cord injury, modulates antioxidation and neurogenesis, and minimizes apoptosis and inflammation. Although commonly administered, methylprednisolone shows uncertain efficacy. The rho-GTPases inhibitor VX-210 and levetiracetam did not demonstrate effectiveness in treatment. Monosialotetrahexosylganglioside Sodium Salt (GM-1) and riluzole are associated with favorable neurological outcomes. Granulocyte Colony-Stimulating Factor (G-CSF) and Hepatocyte Growth Factor (HGF) offer improved motor scores with fewer side effects.