Neurocritical Care

, Volume 30, Issue 2, pp 261–271 | Cite as

Current Topics in the Management of Acute Traumatic Spinal Cord Injury

  • Christopher D. ShankEmail author
  • Beverly C. Walters
  • Mark N. Hadley
Review Article


Acute traumatic spinal cord injury (SCI) affects more than 250,000 people in the USA, with approximately 17,000 new cases each year. It continues to be one of the most significant causes of trauma-related morbidity and mortality. Despite the introduction of primary injury prevention education and vehicle safety devices, such as airbags and passive restraint systems, traumatic SCI continues to have a substantial impact on the healthcare system. Over the last three decades, there have been considerable advancements in the management of patients with traumatic SCI. The advent of spinal instrumentation has improved the surgical treatment of spinal fractures and the ability to manage SCI patients with spinal mechanical instability. There has been a concomitant improvement in the nonsurgical care of these patients with particular focus on care delivered in the pre-hospital, emergency room, and intensive care unit (ICU) settings. This article represents an overview of the critical aspects of contemporary traumatic SCI care and notes areas where further research inquiries are needed. We review the pre-hospital management of a patient with an acute SCI, including triage, immobilization, and transportation. Upon arrival to the definitive treatment facility, we review initial evaluation and management steps, including initial neurological assessment, radiographic assessment, cervical collar clearance protocols, and closed reduction of cervical fracture/dislocation injuries. Finally, we review ICU issues including airway, hemodynamic, and pharmacological management, as well as future directions of care.


Spinal cord injury Closed reduction of cervical fracture Collar clearance in spinal cord injury MAP management CSF diversion in spinal cord injury 



Dr. Shank is the Worthen Family Clinical Scholar at the University of Alabama at Birmingham Department of Neurological Surgery.

Author’s Contributions

All authors contributed to this manuscript in accordance with ICMJE criteria.

Compliance with Ethical Standards


No authors have funding to report relevant to this project.

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    National Spinal Cord Injury Statistical Center. Spinal cord injury (SCI) 2016 facts and figures at a glance. J Spinal Cord Med. 2016;39(4):493–4.CrossRefGoogle Scholar
  2. 2.
    American College of Surgeons. Advanced trauma live support (ATLS) student manual. Chicago: American College of Surgeons; 2012.Google Scholar
  3. 3.
    Vollmer D, Eichler M, Jenkins III A. Spinal trauma: assessment of the cervical spine after trauma. In: Youmans Neurological Surgery. p. 3166–80.Google Scholar
  4. 4.
    Hadley MN, Walters BC. Guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery. 2013;72(3):1–259.Google Scholar
  5. 5.
    Shank CD, Walters BC, Hadley MN. Management of acute traumatic spinal cord injuries. Handb Clin Neurol. 2017;140:275–98.CrossRefPubMedGoogle Scholar
  6. 6.
    Hadley MN, Walters BC, Grabb PA. Guidelines for the management of acute cervical spine and spinal cord injuries. Neurosurgery. 2002;50(3):S2–199.PubMedGoogle Scholar
  7. 7.
    Bellon K, Kolakowsky-Hayner SA, Chen D, McDowell S, Bitterman B, Klaas SJ. Evidence-based practice in primary prevention of spinal cord injury. Top Spinal Cord Inj Rehabil. 2013;19(1):25.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Toscano J. Prevention of neurological deterioration before admission to a spinal cord injury unit. Paraplegia. 1988;26(3):143–50.PubMedGoogle Scholar
  9. 9.
    Kossuth LC. The removal of injured personnel from wrecked vehicles. J Trauma. 1965;5(6):703–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Farrington JD. Extrication of victims–surgical principles. J Trauma. 1968;8(4):493–512.CrossRefPubMedGoogle Scholar
  11. 11.
    Rimel RW, Jane JA, Edlich RF. An educational training program for the care at the site of injury of trauma to the central nervous system. Resuscitation. 1981;9(1):23–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Moylan JA. Trauma injuries: triage and stabilization for safe transfer. Postgrad Med. 1985;78(5):166–71.CrossRefPubMedGoogle Scholar
  13. 13.
    San Mateo County C. EMS System Policy Memorandum #f-3A. 1991.Google Scholar
  14. 14.
    Brown LH, Gough JE, Simonds WB. Can EMS providers adequately assess trauma patients for cervical spinal injury? Prehospital Emerg Care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir. 1998;2(1):33–6.Google Scholar
  15. 15.
    Stroh G, Braude D. Can an out-of-hospital cervical spine clearance protocol identify all patients with injuries? An argument for selective immobilization. Ann Emerg Med. 2001;37(6):609–15.CrossRefPubMedGoogle Scholar
  16. 16.
    Burton JH, Dunn MG, Harmon NR, Hermanson TA, Bradshaw JR. A statewide, prehospital emergency medical service selective patient spine immobilization protocol. J Trauma. 2006;61(1):161–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Liew SC, Hill DA. Complication of hard cervical collars in multi-trauma patients. Aust N Z J Surg. 1994;64(2):139–40.CrossRefPubMedGoogle Scholar
  18. 18.
    Cordell WH, Hollingsworth JC, Olinger ML, Stroman SJ, Nelson DR. Pain and tissue-interface pressures during spine-board immobilization. Ann Emerg Med. 1995;26(1):31–6.CrossRefPubMedGoogle Scholar
  19. 19.
    Linares HA, Mawson AR, Suarez E, Biundo JJ. Association between pressure sores and immobilization in the immediate post-injury period. Orthopedics. 1987;10(4):571–3.PubMedGoogle Scholar
  20. 20.
    Mawson AR, Biundo JJ, Neville P, Linares HA, Winchester Y, Lopez A. Risk factors for early occurring pressure ulcers following spinal cord injury. Am J Phys Med Rehabil Assoc Acad Physiatr. 1988;67(3):123–7.CrossRefGoogle Scholar
  21. 21.
    Hewitt S. Skin necrosis caused by a semi-rigid cervical collar in a ventilated patient with multiple injuries. Injury. 1994;25(5):323–4.CrossRefPubMedGoogle Scholar
  22. 22.
    Blaylock B. Solving the problem of pressure ulcers resulting from cervical collars. Ostomy Wound Manag. 1996;42(4):26–8.Google Scholar
  23. 23.
    Black CA, Buderer NM, Blaylock B, Hogan BJ. Comparative study of risk factors for skin breakdown with cervical orthotic devices: Philadelphia and Aspen. J Trauma Nurs Off J Soc Trauma Nurses. 1998;5(3):62–6.CrossRefGoogle Scholar
  24. 24.
    Bauer D, Kowalski R. Effect of spinal immobilization devices on pulmonary function in the healthy, nonsmoking man. Ann Emerg Med. 1988;17(9):915–8.CrossRefPubMedGoogle Scholar
  25. 25.
    Schafermeyer RW, Ribbeck BM, Gaskins J, Thomason S, Harlan M, Attkisson A. Respiratory effects of spinal immobilization in children. Ann Emerg Med. 1991;20(9):1017–9.CrossRefPubMedGoogle Scholar
  26. 26.
    Totten VY, Sugarman DB. Respiratory effects of spinal immobilization. Prehospital Emerg Care Off J Natl Assoc EMS Physicians Natl Assoc State EMS Dir. 1999;3(4):347–52.Google Scholar
  27. 27.
    Davies G, Deakin C, Wilson A. The effect of a rigid collar on intracranial pressure. Injury. 1996;27(9):647–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Kolb JC, Summers RL, Galli RL. Cervical collar-induced changes in intracranial pressure. Am J Emerg Med. 1999;17(2):135–7.CrossRefPubMedGoogle Scholar
  29. 29.
    Podolsky SM, Hoffman JR, Pietrafesa CA. Neurologic complications following immobilization of cervical spine fracture in a patient with ankylosing spondylitis. Ann Emerg Med. 1983;12(9):578–80.CrossRefPubMedGoogle Scholar
  30. 30.
    Thumbikat P, Hariharan RP, Ravichandran G, McClelland MR, Mathew KM. Spinal cord injury in patients with ankylosing spondylitis: a 10-year review. Spine. 2007;32(26):2989–95.CrossRefPubMedGoogle Scholar
  31. 31.
    Haut ER, Kalish BT, Efron DT, et al. Spine immobilization in penetrating trauma: more harm than good? J Trauma. 2010;68(1):115–20.CrossRefPubMedGoogle Scholar
  32. 32.
    Theodore N, Hadley MN, Aarabi B, et al. Prehospital cervical spinal immobilization after trauma. Neurosurgery. 2013;72(Suppl 2):22–34.CrossRefPubMedGoogle Scholar
  33. 33.
    Cline JR, Scheidel E, Bigsby EF. A comparison of methods of cervical immobilization used in patient extrication and transport. J Trauma. 1985;25(7):649–53.CrossRefPubMedGoogle Scholar
  34. 34.
    De Lorenzo RA. A review of spinal immobilization techniques. J Emerg Med. 1996;14(5):603–13.CrossRefPubMedGoogle Scholar
  35. 35.
    McCabe JB, Nolan DJ. Comparison of the effectiveness of different cervical immobilization collars. Ann Emerg Med. 1986;15(1):50–3.CrossRefPubMedGoogle Scholar
  36. 36.
    Rosen PB, McSwain NE, Arata M, Stahl S, Mercer D. Comparison of two new immobilization collars. Ann Emerg Med. 1992;21(10):1189–95.CrossRefPubMedGoogle Scholar
  37. 37.
    Del Rossi G, Heffernan TP, Horodyski M, Rechtine GR. The effectiveness of extrication collars tested during the execution of spine-board transfer techniques. Spine J Off J North Am Spine Soc. 2004;4(6):619–23.CrossRefGoogle Scholar
  38. 38.
    Hachen HJ. Emergency transportation in the event of acute spinal cord lesion. Paraplegia. 1974;12(1):33–7.PubMedGoogle Scholar
  39. 39.
    Hachen HJ. Idealized care of the acutely injured spinal cord in Switzerland. J Trauma. 1977;17(12):931–6.CrossRefPubMedGoogle Scholar
  40. 40.
    Tator CH, Rowed DW, Schwartz ML, et al. Management of acute spinal cord injuries. Can J Surg J Can Chir. 1984;27(3):289–93.Google Scholar
  41. 41.
    Tator CH, Duncan EG, Edmonds VE, Lapczak LI, Andrews DF. Changes in epidemiology of acute spinal cord injury from 1947 to 1981. Surg Neurol. 1993;40(3):207–15.CrossRefPubMedGoogle Scholar
  42. 42.
    Boyd CR, Corse KM, Campbell RC. Emergency interhospital transport of the major trauma patient: air versus ground. J Trauma. 1989;29(6):789–93.CrossRefPubMedGoogle Scholar
  43. 43.
    Burney RE, Waggoner R, Maynard FM. Stabilization of spinal injury for early transfer. J Trauma. 1989;29(11):1497–9.CrossRefPubMedGoogle Scholar
  44. 44.
    DeVivo MJ, Go BK, Jackson AB. Overview of the national spinal cord injury statistical center database. J Spinal Cord Med. 2002;25(4):335–8.CrossRefPubMedGoogle Scholar
  45. 45.
    Domeier RM, Swor RA, Evans RW, et al. Multicenter prospective validation of prehospital clinical spinal clearance criteria. J Trauma. 2002;53(4):744–50.CrossRefPubMedGoogle Scholar
  46. 46.
    Theodore N, Aarabi B, Dhall SS, et al. Transportation of patients with acute traumatic cervical spine injuries. Neurosurgery. 2013;72(Suppl 2):35–9.CrossRefPubMedGoogle Scholar
  47. 47.
    Hadley MN, Walters BC, Aarabi B, et al. Clinical assessment following acute cervical spinal cord injury. Neurosurgery. 2013;72(Suppl 2):40–53.CrossRefPubMedGoogle Scholar
  48. 48.
    ASIA/IMSOP. International Standards for Neurological and Functional Classification of Spial Cord Injury- Revised 2000. 2000.Google Scholar
  49. 49.
    Kirshblum SC, Memmo P, Kim N, Campagnolo D, Millis S, American Spinal Injury Association. Comparison of the revised 2000 American Spinal Injury Association classification standards with the 1996 guidelines. Am J Phys Med Rehabil Assoc Acad Physiatr. 2002;81(7):502–5.CrossRefGoogle Scholar
  50. 50.
    Savic G, Bergström EMK, Frankel HL, Jamous MA, Jones PW. Inter-rater reliability of motor and sensory examinations performed according to American Spinal Injury Association standards. Spinal Cord. 2007;45(6):444–51.CrossRefPubMedGoogle Scholar
  51. 51.
    Burns AS, Lee BS, Ditunno JF, Tessler A. Patient selection for clinical trials: the reliability of the early spinal cord injury examination. J Neurotrauma. 2003;20(5):477–82.CrossRefPubMedGoogle Scholar
  52. 52.
    Mathen R, Inaba K, Munera F, et al. Prospective evaluation of multislice computed tomography versus plain radiographic cervical spine clearance in trauma patients. J Trauma. 2007;62(6):1427–31.CrossRefPubMedGoogle Scholar
  53. 53.
    Bailitz J, Starr F, Beecroft M, et al. CT should replace three-view radiographs as the initial screening test in patients at high, moderate, and low risk for blunt cervical spine injury: a prospective comparison. J Trauma. 2009;66(6):1605–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Como JJ, Diaz JJ, Dunham CM, et al. Practice management guidelines for identification of cervical spine injuries following trauma: update from the eastern association for the surgery of trauma practice management guidelines committee. J Trauma. 2009;67(3):651–9.CrossRefPubMedGoogle Scholar
  55. 55.
    Ryken TC, Hadley MN, Walters BC, et al. Radiographic assessment. Neurosurgery. 2013;72(Suppl 2):54–72.CrossRefPubMedGoogle Scholar
  56. 56.
    Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. N Engl J Med. 2000;343(2):94–9.CrossRefPubMedGoogle Scholar
  57. 57.
    Stiell IG, Clement CM, McKnight RD, et al. The Canadian C-spine rule versus the NEXUS low-risk criteria in patients with trauma. N Engl J Med. 2003;349(26):2510–8.CrossRefPubMedGoogle Scholar
  58. 58.
    Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841–8.CrossRefPubMedGoogle Scholar
  59. 59.
    Anderson PA, Muchow RD, Munoz A, Tontz WL, Resnick DK. Clearance of the asymptomatic cervical spine: a meta-analysis. J Orthop Trauma. 2010;24(2):100–6.CrossRefPubMedGoogle Scholar
  60. 60.
    Davis JW, Kaups KL, Cunningham MA, et al. Routine evaluation of the cervical spine in head-injured patients with dynamic fluoroscopy: a reappraisal. J Trauma. 2001;50(6):1044–7.CrossRefPubMedGoogle Scholar
  61. 61.
    Pollack CV, Hendey GW, Martin DR, Hoffman JR, Mower WR. NEXUS Group. Use of flexion-extension radiographs of the cervical spine in blunt trauma. Ann Emerg Med. 2001;38(1):8–11.CrossRefPubMedGoogle Scholar
  62. 62.
    Insko EK, Gracias VH, Gupta R, Goettler CE, Gaieski DF, Dalinka MK. Utility of flexion and extension radiographs of the cervical spine in the acute evaluation of blunt trauma. J Trauma. 2002;53(3):426–9.CrossRefPubMedGoogle Scholar
  63. 63.
    Duane TM, Cross J, Scarcella N, et al. Flexion-extension cervical spine plain films compared with MRI in the diagnosis of ligamentous injury. Am Surg. 2010;76(6):595–8.PubMedGoogle Scholar
  64. 64.
    Schuster R, Waxman K, Sanchez B, et al. Magnetic resonance imaging is not needed to clear cervical spines in blunt trauma patients with normal computed tomographic results and no motor deficits. Arch Surg. 2005;140(8):762–6.CrossRefPubMedGoogle Scholar
  65. 65.
    Hennessy D, Widder S, Zygun D, Hurlbert RJ, Burrowes P, Kortbeek JB. Cervical spine clearance in obtunded blunt trauma patients: a prospective study. J Trauma. 2010;68(3):576–82.CrossRefPubMedGoogle Scholar
  66. 66.
    Padayachee L, Cooper DJ, Irons S, et al. Cervical spine clearance in unconscious traumatic brain injury patients: dynamic flexion-extension fluoroscopy versus computed tomography with three-dimensional reconstruction. J Trauma. 2006;60(2):341–5.CrossRefPubMedGoogle Scholar
  67. 67.
    Hadley MN, Shank CD, Rozzelle CJ, Walters BC. Guidelines for the use of electrophysiological monitoring for surgery of the human spinal column and spinal cord. Neurosurgery. 2017;81(5):713–32.CrossRefPubMedGoogle Scholar
  68. 68.
    Hadley MN, Fitzpatrick BC, Sonntag VK, Browner CM. Facet fracture-dislocation injuries of the cervical spine. Neurosurgery. 1992;30(5):661–6.PubMedGoogle Scholar
  69. 69.
    Evans D. Reduction of cervical dislocations. J Bone Jt Surg Br. 1961;43(3):552–5.CrossRefGoogle Scholar
  70. 70.
    Burke DC, Berryman D. The place of closed manipulation in the management of flexion-rotation dislocations of the cervical spine. J Bone Joint Surg Br. 1971;53(2):165–82.CrossRefPubMedGoogle Scholar
  71. 71.
    Sonntag VK. Management of bilateral locked facets of the cervical spine. Neurosurgery. 1981;8(2):150–2.CrossRefPubMedGoogle Scholar
  72. 72.
    Maiman DJ, Barolat G, Larson SJ. Management of bilateral locked facets of the cervical spine. Neurosurgery. 1986;18(5):542–7.CrossRefPubMedGoogle Scholar
  73. 73.
    Star AM, Jones AA, Cotler JM, Balderston RA, Sinha R. Immediate closed reduction of cervical spine dislocations using traction. Spine. 1990;15(10):1068–72.CrossRefPubMedGoogle Scholar
  74. 74.
    O’Conner P, McCormack O, Noel J, McCormack D, O’Byrne J. Anterior displacement correlates with neurological impairment in cervical facet dislocations. Int Orthop. 2003;27(3):190–3.Google Scholar
  75. 75.
    Cowan JA, McGillicuddy JE. Images in clinical medicine: reversal of traumatic quadriplegia after closed reduction. N Engl J Med. 2008;359(20):2154.CrossRefPubMedGoogle Scholar
  76. 76.
    Vaccaro AR, Falatyn SP, Flanders AE, Balderston RA, Northrup BE, Cotler JM. Magnetic resonance evaluation of the intervertebral disc, spinal ligaments, and spinal cord before and after closed traction reduction of cervical spine dislocations. Spine. 1999;24(12):1210–7.CrossRefPubMedGoogle Scholar
  77. 77.
    Doran SE, Papadopoulos SM, Ducker TB, Lillehei KO. Magnetic resonance imaging documentation of coexistent traumatic locked facets of the cervical spine and disc herniation. J Neurosurg. 1993;79(3):341–5.CrossRefPubMedGoogle Scholar
  78. 78.
    Rizzolo SJ, Vaccaro AR, Cotler JM. Cervical spine trauma. Spine. 1994;19(20):2288–98.CrossRefPubMedGoogle Scholar
  79. 79.
    Grant GA, Mirza SK, Chapman JR, et al. Risk of early closed reduction in cervical spine subluxation injuries. J Neurosurg. 1999;90(1 Suppl):13–8.PubMedGoogle Scholar
  80. 80.
    Darsaut TE, Ashforth R, Bhargava R, et al. A pilot study of magnetic resonance imaging-guided closed reduction of cervical spine fractures. Spine. 2006;31(18):2085–90.CrossRefPubMedGoogle Scholar
  81. 81.
    Brunette DD, Rockswold GL. Neurologic recovery following rapid spinal realignment for complete cervical spinal cord injury. J Trauma. 1987;27(4):445–7.CrossRefPubMedGoogle Scholar
  82. 82.
    Greg Anderson D, Voets C, Ropiak R, et al. Analysis of patient variables affecting neurologic outcome after traumatic cervical facet dislocation. Spine J Off J North Am Spine Soc. 2004;4(5):506–12.CrossRefGoogle Scholar
  83. 83.
    Gelb DE, Hadley MN, Aarabi B, et al. Initial closed reduction of cervical spinal fracture-dislocation injuries. Neurosurgery. 2013;72(Suppl 2):73–83.CrossRefPubMedGoogle Scholar
  84. 84.
    Lehmann KG, Lane JG, Piepmeier JM, Batsford WP. Cardiovascular abnormalities accompanying acute spinal cord injury in humans: incidence, time course and severity. J Am Coll Cardiol. 1987;10(1):46–52.CrossRefPubMedGoogle Scholar
  85. 85.
    Grossman RG, Frankowski RF, Burau KD, et al. Incidence and severity of acute complications after spinal cord injury. J Neurosurg Spine. 2012;17(1 Suppl):119–28.CrossRefPubMedGoogle Scholar
  86. 86.
    Hassid VJ, Schinco MA, Tepas JJ, et al. Definitive establishment of airway control is critical for optimal outcome in lower cervical spinal cord injury. J Trauma. 2008;65(6):1328–32.CrossRefPubMedGoogle Scholar
  87. 87.
    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(1):17–29.CrossRefPubMedGoogle Scholar
  88. 88.
    Ledsome JR, Sharp JM. Pulmonary function in acute cervical cord injury. Am Rev Respir Dis. 1981;124(1):41–4.PubMedGoogle Scholar
  89. 89.
    Grande CM, Barton CR, Stene JK. Appropriate techniques for airway management of emergency patients with suspected spinal cord injury. Anesth Analg. 1988;67(7):714–5.CrossRefPubMedGoogle Scholar
  90. 90.
    Shatney CH, Brunner RD, Nguyen TQ. The safety of orotracheal intubation in patients with unstable cervical spine fracture or high spinal cord injury. Am J Surg. 1995;170(6):676–9.CrossRefPubMedGoogle Scholar
  91. 91.
    Hindman BJ, From RP, Fontes RB, et al. Intubation biomechanics: laryngoscope force and cervical spine motion during intubation in cadavers-cadavers versus patients, the effect of repeated intubations, and the effect of type II odontoid fracture on C1–C2 motion. Anesthesiology. 2015;123(5):1042–58.CrossRefPubMedPubMedCentralGoogle Scholar
  92. 92.
    Hindman BJ, Fontes RB, From RP, et al. Intubation biomechanics: laryngoscope force and cervical spine motion during intubation in cadavers-effect of severe distractive-flexion injury on C3-4 motion. J Neurosurg Spine. 2016;1–11.Google Scholar
  93. 93.
    Harrop JS, Sharan AD, Scheid EH, Vaccaro AR, Przybylski GJ. Tracheostomy placement in patients with complete cervical spinal cord injuries: American Spinal Injury Association Grade A. J Neurosurg. 2004;100(1 Suppl Spine):20–3.PubMedGoogle Scholar
  94. 94.
    Berney SC, Gordon IR, Opdam HI, Denehy L. A classification and regression tree to assist clinical decision making in airway management for patients with cervical spinal cord injury. Spinal Cord. 2011;49(2):244–50.CrossRefPubMedGoogle Scholar
  95. 95.
    Leelapattana P, Fleming JC, Gurr KR, Bailey SI, Parry N, Bailey CS. Predicting the need for tracheostomy in patients with cervical spinal cord injury. J Trauma Acute Care Surg. 2012;73(4):880–4.CrossRefPubMedGoogle Scholar
  96. 96.
    Romero J, Vari A, Gambarrutta C, Oliviero A. Tracheostomy timing in traumatic spinal cord injury. Eur Spine J Off Publ Eur Spine Soc Eur Spinal Deform Soc Eur Sect Cerv Spine Res Soc. 2009;18(10):1452–7.CrossRefGoogle Scholar
  97. 97.
    O’Keeffe T, Goldman RK, Mayberry JC, Rehm CG, Hart RA. Tracheostomy after anterior cervical spine fixation. J Trauma. 2004;57(4):855–60.CrossRefPubMedGoogle Scholar
  98. 98.
    Babu R, Owens TR, Thomas S, et al. Timing of tracheostomy after anterior cervical spine fixation. J Trauma Acute Care Surg. 2013;74(4):961–6.CrossRefPubMedGoogle Scholar
  99. 99.
    Wolf A, Levi L, Mirvis S, et al. Operative management of bilateral facet dislocation. J Neurosurg. 1991;75(6):883–90.CrossRefPubMedGoogle Scholar
  100. 100.
    Levi L, Wolf A, Belzberg H. Hemodynamic parameters in patients with acute cervical cord trauma: description, intervention, and prediction of outcome. Neurosurgery. 1993;33(6):1007–16.PubMedGoogle Scholar
  101. 101.
    Vale FL, Burns J, Jackson AB, Hadley MN. Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg. 1997;87(2):239–46.CrossRefPubMedGoogle Scholar
  102. 102.
    Hawryluk G, Whetstone W, Saigal R, et al. Mean arterial blood pressure correlates with neurological recovery after human spinal cord injury: analysis of high frequency physiologic data. J Neurotrauma 2015.Google Scholar
  103. 103.
    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.CrossRefPubMedGoogle Scholar
  104. 104.
    Bracken MB, Collins WF, Freeman DF, et al. Efficacy of methylprednisolone in acute spinal cord injury. JAMA. 1984;251(1):45–52.CrossRefPubMedGoogle Scholar
  105. 105.
    Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990;322(20):1405–11.CrossRefPubMedGoogle Scholar
  106. 106.
    Bracken MB, Shepard MJ, Holford TR, et al. Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up: results of the third National Acute Spinal Cord Injury randomized controlled trial. J Neurosurg. 1998;89(5):699–706.CrossRefPubMedGoogle Scholar
  107. 107.
    Hurlbert RJ, Hadley MN, Walters BC, et al. Pharmacological therapy for acute spinal cord injury. Neurosurgery. 2013;72(Suppl 2):93–105.CrossRefPubMedGoogle Scholar
  108. 108.
    Pointillart V, Petitjean ME, Wiart L, et al. Pharmacological therapy of spinal cord injury during the acute phase. Spinal Cord. 2000;38(2):71–6.CrossRefPubMedGoogle Scholar
  109. 109.
    Matsumoto T, Tamaki T, Kawakami M, Yoshida M, Ando M, Yamada H. Early complications of high-dose methylprednisolone sodium succinate treatment in the follow-up of acute cervical spinal cord injury. Spine. 2001;26(4):426–30.CrossRefPubMedGoogle Scholar
  110. 110.
    Carney N, Totten AM, O’Reilly C, et al. Guidelines for the management of severe traumatic brain injury. Neurosurgery. 2017;80(1):6–15.PubMedGoogle Scholar
  111. 111.
    Werndle MC, Saadoun S, Phang I, et al. Monitoring of spinal cord perfusion pressure in acute spinal cord injury: initial findings of the injured spinal cord pressure evaluation study*. Crit Care Med. 2014;42(3):646–55.CrossRefPubMedGoogle Scholar
  112. 112.
    Scott DA, Denton MJ. Spinal cord protection in aortic endovascular surgery. Br J Anaesth. 2016;117(Suppl 2):ii26–31.CrossRefPubMedGoogle Scholar
  113. 113.
    Khan NR, Smalley Z, Nesvick CL, Lee SL, Michael LM. The use of lumbar drains in preventing spinal cord injury following thoracoabdominal aortic aneurysm repair: an updated systematic review and meta-analysis. J Neurosurg Spine. 2016;25(3):383–93.CrossRefPubMedGoogle Scholar
  114. 114.
    Kwon BK, Curt A, Belanger LM, et al. Intrathecal pressure monitoring and cerebrospinal fluid drainage in acute spinal cord injury: a prospective randomized trial. J Neurosurg Spine. 2009;10(3):181–93.CrossRefPubMedGoogle Scholar
  115. 115.
    Mortazavi MM, Verma K, Tubbs RS, Theodore N. Non-pharmacological experimental treatments for spinal cord injury: a review. Childs Nerv Syst ChNS Off J Int Soc Pediatr Neurosurg. 2012;28(12):2041–5.CrossRefGoogle Scholar
  116. 116.
    Cerebrospinal Fluid Drainage (CSFD) in Acute Spinal Cord Injury [Internet]. 2015;Available from:
  117. 117.
    Thompson S, Zlololow D. Handbook of splinting and casting. Amsterdam: Elsevier; 2012.Google Scholar
  118. 118.
    Williams K. Campbell’s operative orthopedics. 2013.Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • Christopher D. Shank
    • 1
    Email author
  • Beverly C. Walters
    • 1
  • Mark N. Hadley
    • 1
  1. 1.Department of NeurosurgeryUniversity of Alabama at BirminghamBirminghamUSA

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