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We strongly recommend it, but no - you do not have to have one if you choose not to, though we do explain why this is storngly recommended

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One should consider the primary phase lesion and hemorrhaging that results from mechanical damage during SCI as well as the secondary phase lesion that lasts several hours or even several months and is accompanied by edema, hemorrhage, inflammation, and cytotoxic edema [4447] and may extend to the white matter area and lead to white matter degeneration and damage [48, 49]

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