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

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

1. Clinical
   1. See Spinal Cord Syndromes
2. X-ray
   1. See C-spine (NEXUS) and C-Spine X-Ray
3. CT
4. MRI

Management

• 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 Cord Compression (Non-Traumatic)
• C-spine (NEXUS)
• Spinal Column Injuries (Cervical)
• C-Spine X-Ray

Source

• Tintinalli's