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We Have Your Back: ED Presentations, Evaluation, and Management of Spinal Cord Injuries

Due to the high impact causes of most spinal cord injuries, many patients present to the ED via Emergency Medical Services (EMS). Immobilization of anyone at risk for an SCI has been standard practice since the 1970s, despite the lack of evidence-based studies on its efficacy. There are known harms of immobilization, most notably airway compromise, aspiration, and ulcers from prolonged stays in immobilization devices. Despite controversy surrounding immobilization devices, they remain in widespread use due largely to the historical and legal precedent. In fact, no high-quality evidence supports use of these immobilization devices. Treatment recommendations include expediting the removal of…

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 The Changing Standard of Care for Spinal Immobilization

New guidelines suggest a more limited role for prehospital spinal immobilization based on increasing evidence that the practice often is not only unnecessary, but possibly harmful.

Articles of Interest

Traumatic Spinal Cord Injury (SCI)

There is no level I or II evidence that steroids are beneficial. Historically, trials have investigated the use of massive doses of steroids (e.g., gram doses of methylprednisolone). These have been found to cause harm. “The administration of high-dose methylprednisolone, which is associated with significant systemic adverse effects, is strongly discouraged.”

Acute Management of Traumatic Spinal Cord Injury

In most cases of SCI, the spinal cord is still physically intact despite being damaged. It is also possible for the spinal cord to be damaged in the absence of vertebral injury, known as spinal cord injury without radiographic abnormality (SCIWORA).

Emergency Department Management of Cervical Spine Injuries

NEXUS and the Canadian c-spine rule: using clinical decision rules to determine who is safe to discharge without imaging.

Emergency medicine: The need for speed

Although doctors have long known that rapid treatment helps recovery, Fehlings says it is only in the past 25 years that we have started to understand just how crucial time is. He says that “a shift in practice” is emerging, based on research showing that the damage from a spinal cord injury can be limited by early action.

Management of acute spinal cord injury: A summary of the evidence pertaining to the acute management, operative and non-operative management

Acute traumatic spinal cord injury is often a lifechanging and devastating event with considerable mortality and morbidity. Over half a million people suffer from traumatic spinal cord injury annually with the majority resulting from road traffic accidents or falls. The Individual, societal and economic costs are enormous. Initial recognition and treatment of acute traumatic spinal cord injury are crucial to limit secondary injury to the spinal cord and to provide patients with the best chance of some functional recovery.

New Surgical Techniques Help Relieve Pain from Spinal Injury

For spinal cord patients, conventional pain therapies frequently fail, so often doctors suggest the pain is “in their head.” But, Falci says, it's actually in their spinal cord. He resolves it with surgery.

Recognizing Spinal Cord Emergencies

Physicians who work in primary care settings and emergency departments frequently evaluate patients with neck and back pain. Spinal cord emergencies are uncommon, but injury must be recognized early so that the diagnosis can be quickly confirmed and treatment can be instituted to possibly prevent permanent loss of function. The differential diagnosis includes spinal cord compression secondary to vertebral fracture or space-occupying lesion, spinal infection or abscess, vascular or hematologic damage, severe disc herniation and spinal stenosis. The most important information in the assessment of a possible spinal cord emergency comes from the history and the clinical evaluation.

Tasty Morsels of Critical Care...

Like TBI we can split up spinal cord injury into primary and secondary injury. Primary injuries include direct mechanical injury like compression, haematoma, laceration, traction or even complete transection which is thankfully rare.