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Traumatic Spinal Cord Injury
Investigations
- X-ray: AP and lateral films; cervical spine must include C7, otherwise "swimmer's view" or oblique views are needed.
- CT: for fractures/fracture-dislocation, very useful to determine stability.
- MRI: for significant cord injuries, checking discs and haematoma; or patients with objective neurological deficits but no obvious bony injuries.
- MRA: when vertebral arteries are potentially compromised (cervical SCIs with severe traumatic brain injury, fractures and/or dislocations involving foramen transversorium).
Management
Patients with cervical spinal cord injuries (tetraplegia) or high level thoracic cord injuries (paraplegia) with other major trauma such as chest, abdominal injuries, or multiple fractures need to be cared for and monitored in ICU. Other patients will be admitted via Orthopaedic Trauma Unit to the Burwood Spinal Unit.
With any significant spinal cord injuries:
- Bed rest with log-roll (spinal care). Turns every 2-3 hours.
- Ensure airway, breathing and circulation - treat neurogenic shock (with features of low blood pressure but bradycardia) with goal of maintaining systolic pressure >110 mm Hg, or mean arterial pressure >85 mm Hg. Check perfusion and urine output.
- Start prophylactic anticoagulation 24 hours after acute spinal cord injury, e.g., enoxaparin 60 mg subcut once daily. For spinal injuries without cord injury, give enoxaparin 40 mg subcut once daily. Withhold anticoagulant 12 - 24 hours prior to surgical intervention.
- Use prophylactic medications (ranitidine or omeprazole) to prevent stress ulcers.
- Indwelling urethral catheter for bladder drainage and urine output monitoring.
- Daily digital rectal bowel check and evacuation if needed.
- Close monitoring, nursing care (especially skin care), and physiotherapy input. Check regularly for occiput, sacrum, and heel pressure sores.
Topic Code: 17665