Spinal cord trauma

Background

• Penetrating injury
  • GSW
    • Most are stable injuries and only require supportive orthosis, analgesia
    • Give Abx if GSW traversed the abdomen before injuring the cord
    • Bullet removal does not improve neuro status for stable cervical and thoracic lesions
    • Bullet removal may improve neuro status for thoracolumbar region injury (T11-L2)
  • Stabbing
    • Vertebral instability is generally not an issue
    • Delayed deficits are rare
      • If do occur related to retained fragment of blade within spinal canal

Peds

• In pts <10yr spinal injury occurs mainly in upper cervical vertebrae
• In pts >10yr majority of injuries occur in lower cervical spine, similar to adults
• Odontoid fractures are among most common cervical spine injuries in children
  • Do not confuse w/ normal anatomic variations in odontoid seen in children up to 7yr old
• SCIWORA
  • Spinal cord injury without radiologic abnormality
  • MRI has shown significant pathology in many of these pts
  • Symptoms
    • Delayed onset (w/in 48hr) of numbness, paresthesias in extremities
• Transient quadriparesis ("stinger")
  • Occurs most often in boys after sports injuries
  • Paresthesias or weakness of extremities lasting from seconds to minutes
    • Complete recovery w/in 48hr

Diagnosis

1. Clinical
   1. See Spinal Cord Syndromes
2. X-ray
   1. See C-spine (NEXUS) and C-Spine X-Ray
3. CT
4. MRI

Differential Diagnosis

Neck Trauma

• Penetrating neck trauma
• Blunt neck trauma
  • Vertebral and carotid artery dissection
  • Strangulation
  • Whiplash injury
• Cervical injury
  • Cervical fractures and dislocations
  • Cervical injury (peds)
  • Cervical spine clearance
• Neurogenic shock
• Spinal cord injury

Management

• Assess for stability
  • Cervical Spine Injuries
  • Thoracic and Lumbar Spinal Injuries
• Consider intubation for pt w/ injury at C5 or above
• Steroids are no longer recommended
• Complete lesion means absence of sensory and motor function below level of injury
  • May be confused w/ spinal shock
• Surgical intervention indicated for:
  • Progressive neurologic deficits
  • Spinal instability (see Spinal Column Injuries (Cervical))

Steroids

"Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is not Food and Drug Administration (FDA) approved for this application. There is no Class I or Class II medical evidence supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death."

—Pharmacological therapy for acute spinal cord injury., Neurosurgery. 2013 Mar;72 Suppl 2:93-105

See Also

• Penetrating neck trauma
• Blunt neck trauma
• Neurogenic Shock
• Spinal Shock
• Autonomic Dysreflexia
• Thoracic and Lumbar Spine Injuries
• Cervical Spine Injuries
• Vertebral fractures

Source

• Tintinalli's