Rapid diagnosis
and management are essential to have the highest chances of preventing
permanent loss of function.
The spinal cord extends from the base of the skull and terminates near the
lower margin of the L1 vertebral body. Below L1, the spinal canal contains
the lumbar, sacral and coccygeal spinal nerves that comprise the cauda
equina. Therefore, injuries below L1 involve the segmental spinal nerves
and/or cauda equina. Injuries above the termination of the spinal cord at L1
often involve both spinal cord lesions and segmental root or spinal nerve
injuries.
A traumatic spinal cord injury is a lesion of neural elements of the spinal cord
that can result in any degree of sensory and motor deficit, and autonomic or
bowel dysfunction.[3] Spinal cord injuries may be primary or secondary:
Most injuries to the spinal cord don't completely sever it. An injury is more
likely to cause fractures and compression of the vertebrae, which then crush
and destroy the spinal nerve tracts. The prognosis is variable between
almost complete recovery and complete paralysis. Spinal cord injuries are
classified as either complete or incomplete:
An incomplete injury means that the ability of the spinal cord to convey
messages to or from the brain is not completely lost.
Altered consciousness.
Patterns of injury
Brown-Squard's
syndrome:
Spinal shock
Neurogenic shock
Rare.
without radiological
abnormality (SCIWORA)
X-rays:
Normal alertness.
No intoxication.
CT scan:[7]
MRI:[7]
Initial management
Airway management:
Breathing:
Hypotension:
Haemorrhage may be due to other injuries - eg, chest, intraabdominal, retroperitoneal, or pelvic or long bone fractures.
ECG monitoring.
Further treatment
Complications
The neurological deficit often increases during the first few days
following acute spinal cord injury. One of the first signs of deterioration is
the cephalic extension of the sensory deficit.
Severe headache
Intense sweating and skin blotches above the level of the injury
Restlessness
Chest tightness
Bradycardia
Dilated pupils
Hypothermia.
Depression can occur and those with spinal cord injury have an
increased risk of suicide.[22]
Prognosis