Initial Assessment and Management of Patients with Spinal Cord Injury

Jun-Yeong Seo; Jeehyun Yoo

doi:10.4184/jkss.2018.25.2.81

Journal List > J Korean Soc Spine Surg > v.25(2) > 1097578

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Seo and Yoo: Initial Assessment and Management of Patients with Spinal Cord Injury

Review Article

Journal of Korean Spine Surg 2018;25(2):81-89.

Published online: 30 June 2018

DOI: https://doi.org/10.4184/jkss.2018.25.2.81

Initial Assessment and Management of Patients with Spinal Cord Injury

Jun-Yeong Seo, M.D., Ph.D., Jeehyun Yoo, M.D.^∗

Department of Orthopaedic Surgery, Jeju National University Hospital, School of Medicine, Jeju National University, Jeju, Korea

^∗Department of Rehabilitation Medicine, Inje University College of Medicine, Korea

Corresponding author: Jun-Yeong Seo, M.D., Ph.D. ORCID ID: Jun-Yeong Seo: https://orcid.org/0000-0001-8881-7952 Jeehyun Yoo: https://orcid.org/0000-0002-1555-8029 Department of Orthopaedic Surgery, Jeju National University Hospital, Aran 13gil 15, Jeju, 63241, Republic of Korea TEL: +82-64-717-1690, FAX: +82-64-717-1131 E-mail: jys@jejunu.ac.kr

Received 1 March 20186 April 2018 Accepted 15 June 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Study Design

Literature review.

Objectives

To summarize the most up-to-date information on the initial management and neurological examination of patients with spinal cord injury (SCI).

Summary of Literature Review

Secondary injuries result from acute pathophysiological processes such as bleeding, hypoperfusion, inflammation, necrosis, and apoptosis around neural elements that initially survive a mechanical injury.

Materials and Methods

Orthopedic surgeons must be familiar with the anatomy of the spinal cord and the initial management of a patient with SCI. A detailed neurological examination in accordance with the International Standards for the Neurological Classification of Spinal Cord Injury is a prerequisite. It is important to distinguish between spinal shock and neurogenic shock, which are characteristic phenomena in patients with SCI.

Results

Rapid realignment of the spine and proper medical management to avoid hypoperfusion are important in the overall care of a patient with SCI.

Conclusions

Patients with SCI should be managed and treated properly to enable them to return home and to their work as soon as possible.

Keywords: Spinal cord injury, Shock, Motor, Sensory, Reflex

REFERENCES

1. Barson AJ, Sands J. Regional and segmental characteristics of the human adult spinal cord. J Anat. 1977 Jul; 123(Pt 3):797–803.

2. Barson AJ. The vertebral level of termination of the spinal cord during normal and abnormal development. J Anat. 1970 May; 106(Pt 3):489–97.

3. Azar FM, Beaty JH, Canale ST. Campbell's Operative Orthopaedics. 13th ed.Philadelphia: Elsevier;2017. 1572-7.

4. Di Chiro G, Fried LC, Doppman JL. Experimental spinal cord angiography. Br J Radiol. 1970 Jan; 43(505):19–30. DOI: 10.1259/0007-1285-43-505-19.

5. Milen MT, Bloom DA, Culligan J, et al. Albert Adamkiewicz (1850-1921)–his artery and its significance for the retroperitoneal surgeon. World J Urol. 1999 Jun; 17(3):16870. DOI: DOI:10.1007/s003450050126.

6. Dommisse GF. The blood supply of the spinal cord. A critical vascular zone in spinal surgery. J Bone Joint Surg Br. 1974 May; 56(2):225–35. DOI: DOI:10.1302/0301-620x.56b2.225.

7. Levi AD, Hurlbert RJ, Anderson P, et al. Neurologic deterioration secondary to unrecognized spinal instability following trauma–a multicenter study. Spine (Phila Pa 1976). 2006 Feb 15; 31(4):451–8. DOI: 10.1097/01. brs.0000199927.78531.b5.

8. Azar FM, Beaty JH, Canale ST. Campbell's Operative Orthopaedics. 13th ed.Philadelphia: Elsevier;2017. 1756-69.

9. Harris MB, Sethi RK. The initial assessment and management of the multiple-trauma patient with an associated spine injury. Spine (Phila Pa 1976). 2006 May; 31(11 Suppl):9–15. DOI: 10.1097/01.brs.0000217924.56853.0d.

10. 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 Dec; 349(26):2510–8. DOI: DOI:10.1302/0301-620x.56b2.225.: 10.1056/NEJ-Moa031375.

11. Daffner RH, Sciulli RL, Rodriguez A, et al. Imaging for evaluation of suspected cervical spine trauma: a 2-year analysis. Injury. 2006 Jul; 37(7):652–8. DOI: DOI:10.1302/0301-620x.56b2.225.: 10.1016/j.injury.2006.01.018.

12. Available from: http://asia-spinalinjury.org/wp-content/uploads/2016/02/International_Stds_Diagram_Worksheet.pdf.

13. Available from: http://www.isncscialgorithm.com.

14. Delamarter RB, Coyle J. Acute management of spinal cord injury. J Am Acad Orthop Surg. 1999 May-Jun; 7(3):166–75.

15. Ditunno JF, Little JW, Tessler A, et al. Spinal shock revisited: a four-phase model. Spinal Cord. 2004 Jul; 42(7):38395. DOI: DOI:10.1302/0301-620x.56b2.225.: 10.1038/sj.sc.3101603.

16. Nankovic V, Snur I, Nankovic S, et al. [Spinal shock. Diagnosis and therapy. Problems and dilemmas]. Lijec Vjesn. 1995 Jun; 117(2 Suppl):30–2.

17. Kwon BK, Tetzlaff W, Grauer JN, et al. Pathophysiology and pharmacologic treatment of acute spinal cord injury. Spine J. 2004 Jul-Aug; 4(4):451–64. DOI: 10.1016/j.spinee.2003.07.007.

18. Silva NA, Sousa N, Reis RL, et al. From basics to clinical: a comprehensive review on spinal cord injury. Prog Neurobiol. 2014 Mar; 114:25–57. DOI: 10.1016/j.pneurobio.2013.11.002.

19. Kakulas BA. The applied neuropathology of human spinal cord injury. Spinal Cord. 1999 Feb; 37(2):79–88. DOI: DOI:10.1038/sj.sc.3100807.

20. Ramer LM, Ramer MS, Bradbury EJ. Restoring function after spinal cord injury: towards clinical translation of experimental strategies. Lancet Neurol. 2014 Dec; 13(12):124156. DOI: 10.1016/S1474-4422 (14)70144-9.

21. Hadley MN, Walters BC, Grabb PA, et al. Pharmacological therapy after acute cervical spinal cord injury. Neurosurgery. 2002 Mar; 50(3 Suppl):63–72. DOI: 10.1097/00006123-200203001-00013.

22. Morse SD. Acute central cervical spinal cord syndrome. Ann Emerg Med. 1982 Aug; 11(8):436–9. DOI: DOI:10.1016/S0196-0644 (82)80042-5.

Fig. 1.

Worksheet for an imaginary patient with a complete spinal cord injury.

Fig. 2.

Worksheet for an imaginary patient with a spinal cord injury whose American Spinal Injury Association (ASIA) impairment scale score is B.

Fig. 3.

Worksheet of an imaginary patient with a spinal cord injury whose American Spinal Injury Association (ASIA) impairment scale score is C. This differs from Figure 2 in that the motor strength is grade 1 at the T1 level.

Fig. 4.

Worksheet of an imaginary patient with a spinal cord injury whose American Spinal Injury Association (ASIA) impairment scale score is D. In regions where there is no myotome to test, the motor level is presumed to be the same as the sensory level.

TOOLS

Similar articles