The Importance of Vascular Repair as the First Step in Spinal Cord Injury Treatment: Commentary on “Therapeutic Approaches Targeting Vascular Repair After Experimental Spinal Cord Injury: A Systematic Review of the Literature”

The first goal of treatment after spinal cord injury (SCI) is to minimize secondary injury and promote neuronal regeneration, which has been the topic of many studies. In secondary injuries, hemodynamic management is clinically known as a significant treatment. 1 The American Association of Neurological Surgeons/Congress of Neurological Surgeons 2013 SCI guideline recommends maintaining the mean arterial pressure at least between 85 and 90 mmHg for the first 7 days following an acute SCI. 2 In addition, many studies have ac-tively investigated various neuroprotective substances and stem cell treatments after the acute phase. However, there is an overlooked aspect of these treatments—namely, the importance of vascular repair, which could enable proper perfusion pressure, flow, and drug/ cell delivery. In order to maintain proper perfusion pressure in the injured spinal cord tissue, the blood vessels must be distributed appropriately. Furthermore, in order for a sub-stance (e.g., an administered drug or cells) to reach the damaged area, it must be distributed through a blood vessel. In particular, the relationship between vascular repair after SCI and axonal regeneration underscores the importance of vascular repair. 3,4 Therefore, vascular repair is one of the most important issues in the treatment of SCI, and this review paper is very important in this regard. This review paper is broadly divided into a section on the pathophysiology that occurs within spinal cord tissue after damage and a