Primary prevention
In the face of an evolving compressive lesion, early diagnosis and management, including cord decompression, can prevent or reduce the severity of a chronic spinal cord injury (SCI). In acute trauma, early and aggressive resuscitation and correction of hypoxia and hypotension maintains cord vascularity. Minimal handling of the cord, meticulous surgical techniques, early cord decompression, and rigid stabilization of the involved motion segments can prevent, or reduce the severity of, a chronic injury.[13][14]
For traumatic SCI, prevention of injuries due to vehicle accidents, falls, violence, and sports can be achieved by combining individual and societal interventions that aim to increase research in and awareness of effective prevention initiatives and enhance education.[15][16] Law enforcement measures (e.g., alcohol driving limits, laws requiring safety belt and helmet usage), use of safety equipment, and community programs have also been shown to be effective.[17][18]
Primary prevention strategies for nontraumatic myelopathies could include:
Identifying risk factors such as congenitally narrow canals and anomalies that predispose to development of myelopathies (e.g., Down syndrome, Klippel-Feil syndrome)[19]
Exploring genetic and environmental factors (e.g., Epstein-Barr virus [EBV] infection, exposure to silica, cigarette smoking, oral contraceptives, and/or postmenopausal hormone therapy) for multiple sclerosis- or systemic lupus erythematosus-related myelopathy[20][21]
Preventing and treating nutritional deficits like vitamin D (immunomodulatory effect) in patients with autoimmune diseases or those related to inborn errors of metabolism, dietary restriction, or malabsorption (vitamin B12, folate, biotin, vitamin E, or copper)[22][23]
Vaccination and initiation of physical protective barriers to prevent viral or infectious myelopathies such as acute flaccid myelitis, herpesviruses-related myelopathies (cytomegalovirus, human herpes virus 6 and 7, herpes simplex virus 1 and 2, varicella zoster virus, and EBV) and maybe acquired demyelinating disorders (acute disseminated encephalomyelitis, neuromyelitis optica spectrum disorders, and myelin oligodendrocyte glycoprotein antibody-associated disease)
Addressing hypotension during surgical procedures; minimizing cardioembolic risk associated with arrhythmias, atherothrombotic disease, endocarditis, and decompression sickness; and managing hypercoagulable states (sickle cell, malignancies, positive antiphospholipid antibody) for vascular myelopathies[24]
Minimizing spine trauma (fibrocartilaginous embolism) and exposure to radiation (radiation myelopathy)
Monitoring for signs of progressive myelopathy in metabolic storage disorders[25]
Increasing awareness and education about the dangers of nitrous oxide inhalation that could induce subacute degeneration of the spinal cord and would help prevent the onset of possible neurologic deficit.[26]
Secondary prevention
Normal thromboprophylaxis is required for medical illness or surgery. In one study, only 38% of patients admitted to inpatient rehabilitation sites were receiving thromboprophylaxis.[158][159] See Venous thromboembolism (VTE) prophylaxis.
Good nursing care, regular changes in position, and padding can be used to prevent pressure ulcers if the patient is immobile for long periods. See Pressure ulcer.
Maintenance of physical therapy and use of stents helps to prevent contractures.
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