A massive localized trauma to the spinal cord results in complex pathologic events driven
by necrosis and vascular damage which in turn leads to hemorrhage and edema. Severe, destructive
and very protracted inflammatory response is characterized by infiltration by phagocytic
macrophages of a site of injury which is converted into a cavity of injury (COI) surrounded by astroglial
reaction mounted by the spinal cord. The tissue response to the spinal cord injury (SCI) has
been poorly understood but the final outcome appears to be a mature syrinx filled with the cerebrospinal
fluid with related neural tissue loss and permanent neurologic deficits. This paper reviews
known pathologic mechanisms involved in the formation of the COI after SCI and discusses
the integrative role of reactive astrogliosis in mechanisms involved in the removal of edema after
the injury. A large proportion of edema fluid originating from the trauma and then from vasogenic
edema related to persistent severe inflammation, may be moved into the COI in an active process
involving astrogliosis and specifically over-expressed aquaporins.
Keywords: Spinal cord injury, inflammation, cavity of injury, astrogliosis, aquaporins, edema, syrinx.
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