The History of Spinal Cord Injury Medical Management

The History of Spinal Cord Injury Medical Management

November 7, 2025

Mark Gaied,

Reem Bader

A Remarkable Shift from Hopeless Resignation to a Model of Comprehensive, Multidisciplinary Care

The history of medical management for spinal cord injury (SCI) mirrors the broader story of medical progress. In ancient times, SCI was considered hopeless. Today, it is treated with surgery, rehabilitation, and ongoing research toward a cure.1,2,3 The transition from resignation to comprehensive care reflects centuries of experimentation, innovation, and continuous refinement of knowledge.1,2

Ancient Times: An Ailment Not to Be Treated

The earliest written description of SCI comes from the Edwin Smith Surgical Papyrus in ancient Egypt, dating back to around 3,000 to 2,500 BCE.2,4,5 This document recorded numerous traumatic injuries, including several cases involving the spine, and described SCI as “an ailment not to be treated.”1,2 This assessment reflected the seriousness of the condition, as paralysis caused by SCI was untreatable with the medical tools available at that time. For many centuries, this gloomy outlook influenced medical practice.

However, some early interventions were attempted. Traction techniques were developed to reduce spinal deformities and maintain alignment.1,2,6 Careful attention was also paid to preventing ulcers and other complications caused by immobility.1,2 Over time, doctors began to understand that paralysis resulted directly from injury to the spinal cord rather than the vertebral bones.2 This realization gradually led to efforts like decompression, such as removing part of the vertebra to relieve pressure, and splinting, which provided early stabilization.2,6 These measures marked the initial move away from passive observation toward active, though still limited, treatment.

Medieval to Renaissance Periods

Throughout the medieval period, SCI was still largely considered fatal. In less severe cases, however, stabilization and reduction techniques were promoted to prevent the injury from worsening.2,6 Some physicians recommended immediate attention to fractures, while others emphasized cleaner surgical methods, foreseeing the later importance of antisepsis.2

By the Renaissance, surgical approaches became more experimental. Laminectomy, the removal of vertebral bone to relieve pressure on the spinal cord, was described as a potential treatment, though outcomes were poor and survival was rare.2,5,6 Techniques for open and closed reduction of dislocations were developed, and the study of spinal anatomy became more detailed.2,4 Even early attempts at tumor removal within the spinal canal were reported.4 While success was limited, these practices showed a growing willingness to attempt intervention rather than accept paralysis as inevitable.

Ancient Medical Practices

The 19th Century: Debate and Practical Management

The 19th century sparked new debates over whether surgery was helpful for SCI. Some doctors believed that operating was worthwhile since many patients would die without it, while others argued that surgery caused more harm.1,2,6

What shifted the debate was advances in other areas of medicine. Anesthesia enabled complex surgeries to be performed without unbearable pain, while antiseptic practices and improved wound care reduced infections.1,2,6 Blood transfusions and sterile surgical techniques further increased survival rates. These developments created the conditions for more serious attempts at surgical decompression and spinal stabilization.

Immobilization strategies also improved. Physicians started using plaster casts, spinal jackets, and early wiring techniques to stabilize the spine after fractures or surgery.2 Practical management became equally important. Adjusting schedules to prevent pressure sores, ensuring bladder drainage to prevent infections, and maintaining careful positioning were recognized as crucial components of care.6,7 Finally, the discovery of X-rays in 1895 provided the first reliable way to visualize spinal fractures, transforming diagnosis and guiding treatment.1,2,6

World Wars and the Development of Modern Care

The First World War led to unprecedented numbers of spinal injuries, prompting advancements in medicine. Dedicated units for spinal care began to form, where systematic treatment improved survival rates. Rehabilitation and physical training were incorporated into care, and specialized centers combined research with patient treatment. Importantly, the concept of “secondary injury” arose, emphasizing that damage to the spinal cord can continue after the initial trauma and may be limited with timely intervention.

When World War II began in 1939, it marked a major turning point. Permanent spinal centers were created, combining surgery, nursing, rehabilitation, and social reintegration in one facility.1,2,3,6 Antibiotics decreased life-threatening infections, while improved battlefield evacuation methods and surgical techniques lowered death rates. Skeletal traction, plaster casting, and early internal fixation devices offered better stabilization. For the first time, many people with SCI survived for years instead of weeks.2

Post-War to the Present: Comprehensive Care and Life Expectancy

After 1945, when both world wars had ended, specialized systems of lifelong care for SCI became the norm. In the United States, the federally funded Model Systems and the Veterans Health Administration established networks of spinal injury centers focused on interdisciplinary management, rehabilitation, and research.1,3 Surgical stabilization advanced further with the introduction of rods, plates, and screws to correct deformities and keep the spine aligned.1,2 Imaging was transformed by CT and MRI, which offered detailed views of both bone and spinal cord.1,2 Medications were developed to manage spasticity, pain, and other complications, while technologies such as functional electrical stimulation, power wheelchairs, and environmental control systems enhanced independence and daily living.1,2

At the same time, societal progress influenced care. Legislation like the Americans with Disabilities Act, passed in 1990, secured greater rights for individuals with SCI, while advances in urologic management lowered deaths from kidney failure, helping people live longer.1 These changes, along with advances in acute and chronic care, have transformed survival patterns for SCI over the past 50 years.9 Although the period immediately after injury remains the most dangerous, mortality within the first two years post-injury dropped by 40% between 1973 and 2004, reflecting significant progress in critical care.10 Beyond this early phase, however, life expectancy has shown little improvement in recent decades.9,10

Next Steps

Looking ahead, ongoing research continues to build on the advances made after the wars. Promising areas of investigation include stem cell therapies, strategies to promote axon growth, regenerative rehabilitation, and methods to reduce neurocircuit deficits. Other emerging approaches, such as brain-computer interface technology, remain in the early stages of testing and require further evaluation to establish both safety and effectiveness.1,6 At the same time, progress in rehabilitation is expanding to include advanced equipment, virtual care platforms, and strategies to ensure that innovative treatments are accessible to all individuals living with SCI. Efforts to minimize the effects of secondary damage also remain essential, emphasizing proactive and preventative management. Although a complete cure is not yet within reach, each of these steps moves treatment closer to the ultimate goal of restoring lost function and improving quality of life.1,2

Modern Medicine

References

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  2. Mobbs RJ, Chau AMT, Rao PJ. The history of spinal surgery. J Clin Neurosci. 2011;18(3):280-285. doi:10.1016/j.jocn.2010.06.002
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  4. Woertgen C, Rothoerl RD, Brawanski A. The Edwin Smith papyrus: description of spinal injuries in an Egyptian surgical treatise. Spine. 1999;24(24):2663-2666. doi:10.1097/00007632-199912150-00021
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  7. Wilkins RH. Neurosurgical classic—Harvey Cushing on missile wounds of the spine. J Neurosurg. 1978;48(1):1-6. doi:10.3171/jns.1978.48.1.0001
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  9. Middleton JW, Dayton A, Walsh J, Rutkowski SB, Leong G, Duong S. Life expectancy after spinal cord injury: a 50-year study. Spinal Cord. 2012;50(11):803–811. doi:10.1038/sc.2012.55
  10. Strauss DJ, Devivo MJ, Paculdo DR, Shavelle RM. Trends in life expectancy after spinal cord injury. Arch Phys Med Rehabil. 2006;87(8):1079–1085. doi:10.1016/j.apmr.2006.04.014