Traumatic spinal cord injury

Trauma to the spinal cord can have devastating functional consequences, and treatments are limited once the injury is fully established. Therefore, any patient with possible acute neck trauma should have the neck immobilized in the field until the injury can be excluded by appropriate imaging. Once in the Emergency Department, a focused but detailed examination and CT scanning of the spine can reliably determine if spinal cord injury has occurred, though its severity may be confounded by the initial spinal shock. Severe spinal cord injury is often associated with circulatory shock (neurogenic or hypovolemic), and this must be immediately corrected to prevent secondary injury from spinal cord hypoperfusion. When indicated, definite surgical stabilization should be pursued within the first 1-2 days. Prognosis should be approached cautiously during the early phase. This chapter will provide a practical overview of the acute evaluation and medical management of traumatic spinal cord injury.