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
- GSW
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
- Clinical
- X-ray
- See C-spine (NEXUS) and C-Spine X-Ray
- CT
- MRI
Management
- Assess for stability
- 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))
See Also
- Neurogenic Shock
- Spinal Shock
- Spinal Cord Compression (Non-Traumatic)
- C-spine (NEXUS)
- Spinal Column Injuries (Cervical)
- C-Spine X-Ray
- Autonomic Dysreflexia
- Spinal Column Injuries (Thoracolumbar)
Source
- Tintinalli's