Neurologic Recovery in Polytrauma Patients With Acute Spinal Cord Injury

Traumatic spinal cord injury results in devastating and lifelong neurologic impairment in thousands of individuals each year. An understanding of the factors that influence neurologic outcome in polytrauma patients with a spinal cord injury allows for early treatment, which may improve neurologic recovery. Neurologic impairment in polytrauma patients with spinal cord injury is clinically classified based on the American Spinal Injury Association International Standards for Neurological Classification of Spinal Cord Injury. In general, neurologic recovery is worse in patients with more severe initial neurologic impairment, in patients with a higher level spinal cord injury (cervical versus thoracic), and in older patients. MRI features and neurochemical biomarkers in cerebrospinal fluid are used to objectively assess spinal cord injury severity and better predict patient outcomes. Well-accepted therapeutic interventions to improve neurologic recovery in polytrauma patients with a spinal cord injury include early surgical decompression/stabilization and maintenance of spinal cord perfusion by augmenting mean arterial pressure and avoiding hypotension. Early surgical decompression (within 24 hours postinjury) may be beneficial in polytrauma patients with acute spinal cord injury. The goal of mean arterial pressure augmentation is to improve spinal cord perfusion, and intrathecal pressure monitoring (to calculate spinal cord perfusion pressure) may improve the effectiveness of hemodynamic management, helping to avoid ischemic secondary spinal cord injury. Transfer of polytrauma patients with a spinal cord injury to a specialized medical center with expertise in the surgical and postoperative management of such injuries is necessary to ensure optimal neurologic and nonneurologic patient outcomes.