Spine Trauma

There are five important steps in the treatment of a neurologic deficit associated with spinal cord injury:

• 1) immobilization,
• 2) medical stabilization,
• 3) spinal alignment,
• 4) surgical decompression if compression of neurologic structures exists, and
• 5) spinal stabilization.

Immobilization:

• should be carried out at the scene of the injury
• sandbags to support the head or a rigid cervical collar are used to immobilize the head and neck
• Continuous movement of an injured cord will exacerbate the pathologic damage to the cord. A preliminary examination should be done in the field by EMTs, including check for spontaneous movement of all four extremities as well as performance of a rectal examination to check for tone and the victim’s ability to “clamp down.”

Medical stabilization:

• Maintenance of airway and ventilation which may be hampered by paralyzed intercostals. Intubation is sometimes required but is riskier in the face of cervical injury.

• Maintenance of a diastolic blood pressure of 70 mm Hg or greater is important as it has been shown to be deleterious to spinal cord recovery if the diastolic is 69 mm Hg or less.
• In the high thoracic or cervical lesion, the sympathetic influence on cardiac function may be injured. Lack of sympathetic input to the heart may compromise cardiac output and thereby not provide adequate perfusion pressure to the spinal cord.
• Parasympathetic control to the heart is usually unaffected via the vagus nerve.

Spinal alignment:

• Vertebral dislocations produce cord compression. Immediate reduction of these injuries is required:
• Cervical tong traction is used for dislocations of cervical spine
• Thoracic and lumbar dislocations usually require operative reduction
• Decompressive surgical procedures should be carried out only if there is proven compression of the neural elements following spinal alignment. Bone, ligamentous tissue, or foreign bodies (i.e. bullet) may displace the cord.

Surgical Decompression:

• If there is still compression on the cord after realignment, surgical decompression to create space for the should be undertaken.

Stabilization:

• Different methods of spinal stabilization are available ranging from cervical collars to thoracolumbosacral orthotic to hold the spine immobilized while it heals.
• The healing of bone and ligament tissues usually require several months or more to heal.