CC BY-NC-ND 4.0 · Indian Journal of Neurotrauma 2020; 17(02): 057-061
DOI: 10.1055/s-0040-1713556
Review Article

Emergency Management of Traumatic Spinal Cord Injuries

Mohammed Maan Abdul Azeez
1   College of Medicine, University of Baghdad, Baghdad, Iraq
,
Luis Rafael Moscote-Salazar
2   Consejo Latinoamericano de Neurointensivismo- CLaNi, Cartagena, Colombia
3   Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
,
Gabriel Alcala-Cerra
3   Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
,
Ezequiel García-Ballestas
2   Consejo Latinoamericano de Neurointensivismo- CLaNi, Cartagena, Colombia
3   Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
,
Diego Bustos-Salazar
3   Centro De Investigaciones Biomédicas (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
,
Guru Dutta Satyarthee
4   Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
,
Amit Agrawal
5   Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
› Author Affiliations

Abstract

Spinal cord trauma constitutes one of the main causes of mortality and morbidity in young adults around the world, with an estimated 2 to 3 new cases for every 100,000 population. Road traffic accidents, falls from high heights, sports injuries, and violent actions are common causes of spinal cord injuries. There is no “gold standard” for the diagnosis of spinal cord traumatic injuries; however, the rational use of conventional radiologic test, computed tomography scan, and magnetic resonance imaging (MRI) will allow to identify almost all clinically relevant injuries. MRI is recommended according to surgeon’s criteria, who after evaluating the specific characteristics of the injury will determine its usefulness. Therapeutic strategies need to be directed to maintain airway, breathing and circulation, maintenance of mean arterial pressure prevention of hypotension, and assessment of other associated injuries. Intensive treatment must be focused on the prevention and management of ventilatory and cardiovascular abnormalities related to muscle weakness and loss of autonomic innervation.



Publication History

Article published online:
09 September 2020

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  • References

  • 1 Lee BB, Cripps RA, Fitzharris M, Wing PC. The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate. Spinal Cord 2014; 52 (02) 110-116
  • 2 Rowland JW, Hawryluk GW, Kwon B, Fehlings MG. Current status of acute spinal cord injury pathophysiology and emerging therapies: promise on the horizon. Neurosurg Focus 2008; 25 (05) E2
  • 3 Stein DM, Roddy V, Marx J, Smith WS, Weingart SD. Emergency neurological life support: traumatic spine injury. Neurocrit Care 2012; 17 (Suppl. 01) S102-S111
  • 4 Schouten R, Albert T, Kwon BK. The spine-injured patient: initial assessment and emergency treatment. J Am Acad Orthop Surg 2012; 20 (06) 336-346
  • 5 Singh R, Rohilla RK, Sangwan K, Siwach R, Magu NK, Sangwan SS. Bladder management methods and urological complications in spinal cord injury patients. Indian J Orthop 2011; 45 (02) 141-147
  • 6 Consortium for Spinal Cord Medicine. Early acute management in adults with spinal cord injury: a clinical practice guideline for health-care professionals. J Spinal Cord Med 2008; 31 (04) 403-479
  • 7 Schmidt OI, Gahr RH, Gosse A, Heyde CE. ATLS(R) and damage control in spine trauma. World J Emerg Surg 2009; 4: 9
  • 8 Ahn H, Singh J, Nathens A. et al. Pre-hospital care management of a potential spinal cord injured patient: a systematic review of the literature and evidence-based guidelines. J Neurotrauma 2011; 28 (08) 1341-1361
  • 9 Theodore N, Hadley MN, Aarabi B. et al. Prehospital cervical spinal immobilization after trauma. Neurosurgery 2013; 72 (Suppl. 02) 22-34
  • 10 Association ASI. International Standards for Neurological Classification of Spinal Cord Injury. Chicago: ASIA; 2015
  • 11 Ryken TC, Hadley MN, Walters BC. et al. Radiographic assessment. Neurosurgery 2013; 72 (Suppl. 02) 54-72
  • 12 Berney S, Bragge P, Granger C, Opdam H, Denehy L. The acute respiratory management of cervical spinal cord injury in the first 6 weeks after injury: a systematic review. Spinal Cord 2011; 49 (01) 17-29
  • 13 Jia X, Kowalski RG, Sciubba DM, Geocadin RG. Critical care of traumatic spinal cord injury. J Intensive Care Med 2013; 28 (01) 12-23
  • 14 Shank CD, Walters BC, Hadley MN. Management of acute traumatic spinal cord injuries. Handb Clin Neurol 2017; 140: 275-298
  • 15 Ryken TC, Hurlbert RJ, Hadley MN. et al. The acute cardiopulmonary management of patients with cervical spinal cord injuries. Neurosurgery 2013; 72 (Suppl. 02) 84-92
  • 16 Witiw CD, Fehlings MG. Acute spinal cord injury. J Spinal Disord Tech 2015; 28 (06) 202-210
  • 17 Dhall SS, Hadley MN, Aarabi B. et al. Nutritional support after spinal cord injury. Neurosurgery 2013; 72 (Suppl. 02) 255-259
  • 18 Todd NV. Priapism in acute spinal cord injury. Spinal Cord 2011; 49 (10) 1033-1035
  • 19 Kessler TM, Traini LR, Welk B, Schneider MP, Thavaseelan J, Curt A. Early neurological care of patients with spinal cord injury. World J Urol 2018; 36 (10) 1529-1536
  • 20 Dhall SS, Hadley MN, Aarabi B. et al. Deep venous thrombosis and thromboembolism in patients with cervical spinal cord injuries. Neurosurgery 2013; 72 (Suppl. 02) 244-254
  • 21 Hurlbert RJ, Hadley MN, Walters BC. et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery 2013; 72 (Suppl. 02) 93-105