Table 1.

A timeline of the sequence of pathophysiological processes that occur from the onset of primary injury to secondary injury.

Phase	Physiological processes
Acute (Up to 72 hours)	- Cord oedema, intracellular swelling - Hemorrhage - Regional cord perfusion shifts - Inflammatory response: free radical production, lipid peroxidation and cytokine release - Membrane instability: shifts in electrolytes and accumulation of neurotransmitters - Demyelination - Cell necrosis and apoptosis
Sub-acute (days to weeks)	- Proximal and distal extension of oedema, necrosis and apoptosis - Continued inflammatory response - Vascular angiopathy - Peak levels of astrocyte and macrophage activity - Initial scar formation - Neuroplasticity - Spasticity
Chronic (months to years)	- Formation of fluid – filled cavity - Wallerian degeneration - Glial scar formation - Demyelination - Schwann cell proliferation - Syringomyelia - Tethered cord - Neurite sprouting, altered neurocircuits and chronic pain syndromes

Reprinted from Mataliotakis and Tsirikos (19) with permission from Elsevier.