Current Topics in the Management of Acute Traumatic Spinal Cord Injury

  • Christopher D. Shank
  • Beverly C. Walters
  • Mark N. Hadley
Review Article
  • 56 Downloads

Abstract

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.

Keywords

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

Notes

Acknowledgements

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

Funding

No authors have funding to report relevant to this project.

Conflict of interest

The authors declare that they have no conflicts of interest.

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Copyright information

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

Authors and Affiliations

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

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