Abstract
Trauma to the spinal cord can have devastating functional consequences, and treatments are limited once the injury is fully established. Therefore, any patient with possible acute neck trauma should have the neck immobilized in the field until the injury can be excluded by appropriate imaging. Once in the Emergency Department, a focused but detailed examination and CT scanning of the spine can reliably determine if spinal cord injury has occurred, though its severity may be confounded by the initial spinal shock. Severe spinal cord injury is often associated with circulatory shock (neurogenic or hypovolemic), and this must be immediately corrected to prevent secondary injury from spinal cord hypoperfusion. When indicated, definite surgical stabilization should be pursued within the first 1–2 days. Prognosis should be approached cautiously during the early phase. This chapter will provide a practical overview of the acute evaluation and medical management of traumatic spinal cord injury.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. Spinal Cord. 2012;50(5):365–72.
Rabinstein AA. Traumatic spinal cord injury. Continuum (Minneap Minn). 2018;24(2., Spinal Cord Disorders):551–66.
Hadley MN, Walters BC, Grabb PA, et al. Clinical assessment after acute cervical spinal cord injury. Neurosurgery. 2002;50(3 Suppl):S21–9.
Maynard FM Jr, Bracken MB, Creasey G, et al. International standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Spinal Cord. 1997;35(5):266–74.
Walters BC, Hadley MN, Hurlbert RJ, et al. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery. 2013;60(CN_suppl_1):82–91.
Boese CK, Lechler P. Spinal cord injury without radiologic abnormalities in adults: a systematic review. J Trauma Acute Care Surg. 2013;75(2):320–30.
Shank CD, Walters BC, Hadley MN. Current topics in the management of acute traumatic spinal cord injury. Neurocrit Care. 2019;30(2):261–71.
Parent S, Barchi S, LeBreton M, Casha S, Fehlings MG. The impact of specialized centers of care for spinal cord injury on length of stay, complications, and mortality: a systematic review of the literature. J Neurotrauma. 2011;28(8):1363–70.
Fehlings MG, Vaccaro A, Wilson JR, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the Surgical Timing in Acute Spinal Cord Injury Study (STASCIS). PLoS One. 2012;7(2):e32037.
Ryken TC, Hurlbert RJ, Hadley MN, et al. The acute cardiopulmonary management of patients with cervical spinal cord injuries. Neurosurgery. 2013;72(Suppl 2):84–92.
Squair JW, Belanger LM, Tsang A, et al. Spinal cord perfusion pressure predicts neurologic recovery in acute spinal cord injury. Neurology. 2017;89(16):1660–7.
Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev. 2012;(1):CD001046.
Hagen EM. Acute complications of spinal cord injuries. World J Orthop. 2015;6(1):17–23.
Brown R, Burton AR, Macefield VG. Autonomic dysreflexia: Somatosympathetic and viscerosympathetic vasoconstrictor responses to innocuous and noxious sensory stimulation below lesion in human spinal cord injury. Auton Neurosci. 2018;209:71–8.
Wilson JR, Cadotte DW, Fehlings MG. Clinical predictors of neurological outcome, functional status, and survival after traumatic spinal cord injury: a systematic review. J Neurosurg Spine. 2012;17(1 Suppl):11–26.
Talbott JF, Whetstone WD, Readdy WJ, et al. The Brain and Spinal Injury Center score: a novel, simple, and reproducible method for assessing the severity of acute cervical spinal cord injury with axial T2-weighted MRI findings. J Neurosurg Spine. 2015;23(4):495–504.
Bozzo A, Marcoux J, Radhakrishna M, Pelletier J, Goulet B. The role of magnetic resonance imaging in the management of acute spinal cord injury. J Neurotrauma. 2011;28(8):1401–11.
Nagoshi N, Okano H. Applications of induced pluripotent stem cell technologies in spinal cord injury. J Neurochem. 2017;141(6):848–60.
Chamberlain JD, Meier S, Mader L, von Groote PM, Brinkhof MW. Mortality and longevity after a spinal cord injury: systematic review and meta-analysis. Neuroepidemiology. 2015;44(3):182–98.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2020 Springer Nature Switzerland AG
About this chapter
Cite this chapter
Rabinstein, A.A. (2020). Traumatic Spinal Cord Injury. In: Rabinstein, A. (eds) Neurological Emergencies. Springer, Cham. https://doi.org/10.1007/978-3-030-28072-7_14
Download citation
DOI: https://doi.org/10.1007/978-3-030-28072-7_14
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-030-28071-0
Online ISBN: 978-3-030-28072-7
eBook Packages: MedicineMedicine (R0)