Acute Treatment of Spinal Cord Injury

At the authors' institution, a multidisciplinary team of trauma physicians, neurosurgeons, and anesthesiologists evaluates patients with suspected spinal cord injury. Our initial goal after resuscitation and evaluation is to assure adequate tissue oxygenation through blood pressure support and oxygen supplementation. This supplementation helps ensure maximal oxygen delivery to the injured spinal cord. It is important that a detailed and standardized neurologic examination is performed and repeated often to detect neurologic decline. Immediately after a potential spinal cord injury is identified, methylprednisolone is administered (ideally during transport from the accident scene). Plain x-rays of the spine are the first films obtained. Once a fracture is identified, a computerized CT scan through the identified region is done. If the injury involves the cervical spine, and reduction is needed to correct a deformity, closed reduction with placement of a halo-fixation device is performed in the emergency room. We believe that reduction to normal spinal alignment should be accomplished within a few hours of the injury. Once initial immobilization efforts are complete, the patient gets an magnetic resonance image (MRI) of the affected region. Most spinal cord injury patients at our institution do not undergo emergency surgery. Urgent surgery is only performed in those with continued neurologic decline, and MRI findings of acute compression from lesions such as a ruptured disc or epidural hematoma.