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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Personalized Management Strategies in Traumatic Spinal Cord Injury: From Resuscitation to Definitive Surgical Care

  • Peem Sarasombath1
  • Patawut Bovonratwet2
  • Chaisiri Chaichankul1
  • Roongrath Chitragran1
  • Pawin Gajaseni1
  • Chaiyapruk Pundee3
  • Wongthawat Liawrungrueang3
  • Oluwafemi P. Owodunni4
  • Pakawat Chongsathidkiet5
  • Torphong Bunmaprasert6
6 affiliations
  1. 1Department of Orthopedics, Phramongkutklao Hospital and College of Medicine, Bangkok 10400, Thailand
  2. 2Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
  3. 3Department of Orthopedics, Samitivej Srinakarin Hospital, Bangkok 10250, Thailand
  4. 4Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM 87106, USA
  5. 5Department of Neurosurgery, Duke University School of Medicine, Durham, NC 27710, USA
  6. 6Department of Orthopedics, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand
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Abstract

Personalized management of traumatic spinal cord injury (TSCI) is an emerging approach in modern spine and trauma care. Unlike traditional protocol-driven approaches that apply uniform resuscitation, imaging, and surgical strategies across heterogeneous injury patterns, individualized care pathways that account for biological, physiological, and injury-specific variability may improve neurological outcomes and resource utilization. This review summarizes contemporary concepts in personalized TSCI management spanning prehospital and initial hospital care, resuscitation, imaging, and definitive surgical decision-making. The proposed framework is informed by evidence from clinical trials, observational studies, and emerging consensus statements, emphasizing stratified approaches based on neurological status, injury mechanism, physiological reserve, and imaging biomarkers. Selective spinal motion restriction, hemodynamic support within guideline ranges, and early decompression are supported by current guidelines, albeit based largely on low-quality evidence, whereas individualized hemodynamic targets, advanced neuroimaging, blood-based biomarkers, and artificial intelligence-based risk stratification remain emerging strategies that require prospective validation before routine clinical use. In conclusion, personalized management across the continuum of TSCI care provides a rational framework with potential clinical applications, although its effect on patient outcomes remains to be demonstrated.

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Cite

BibTeXRIS
BibTeX
@article{sarasombath2026personalized,
  title = {{Personalized Management Strategies in Traumatic Spinal Cord Injury: From Resuscitation to Definitive Surgical Care}},
  author = {Peem Sarasombath and Patawut Bovonratwet and Chaisiri Chaichankul and Roongrath Chitragran and Pawin Gajaseni and Chaiyapruk Pundee and Wongthawat Liawrungrueang and Oluwafemi P. Owodunni and Pakawat Chongsathidkiet and Torphong Bunmaprasert},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15207923},
  url = {https://www.mdpi.com/2077-0383/15/20/7923},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Personalized Management Strategies in Traumatic Spinal Cord Injury: From Resuscitation to Definitive Surgical Care
AU  - Peem Sarasombath
AU  - Patawut Bovonratwet
AU  - Chaisiri Chaichankul
AU  - Roongrath Chitragran
AU  - Pawin Gajaseni
AU  - Chaiyapruk Pundee
AU  - Wongthawat Liawrungrueang
AU  - Oluwafemi P. Owodunni
AU  - Pakawat Chongsathidkiet
AU  - Torphong Bunmaprasert
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15207923
UR  - https://www.mdpi.com/2077-0383/15/20/7923
AB  - Personalized management of traumatic spinal cord injury (TSCI) is an emerging approach in modern spine and trauma care. Unlike traditional protocol-driven approaches that apply uniform resuscitation, imaging, and surgical strategies across heterogeneous injury patterns, individualized care pathways that account for biological, physiological, and injury-specific variability may improve neurological outcomes and resource utilization. This review summarizes contemporary concepts in personalized TSCI management spanning prehospital and initial hospital care, resuscitation, imaging, and definitive surgical decision-making. The proposed framework is informed by evidence from clinical trials, observational studies, and emerging consensus statements, emphasizing stratified approaches based on neurological status, injury mechanism, physiological reserve, and imaging biomarkers. Selective spinal motion restriction, hemodynamic support within guideline ranges, and early decompression are supported by current guidelines, albeit based largely on low-quality evidence, whereas individualized hemodynamic targets, advanced neuroimaging, blood-based biomarkers, and artificial intelligence-based risk stratification remain emerging strategies that require prospective validation before routine clinical use. In conclusion, personalized management across the continuum of TSCI care provides a rational framework with potential clinical applications, although its effect on patient outcomes remains to be demonstrated.
SN  - 2077-0383
ER  -