Spinal Cord Injury, Questions

1. What imaging do you use for patients with possible acute, traumatic spinal cord injury?

2. How do you treat neurogenic shock?

3. What is your management and disposition for elderly patients with vertebral compression fractures?

4. How do you clear a C-spine after a negative CT in a trauma patient who is awake, neuro intact, wearing a collar?

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2 Responses to Spinal Cord Injury, Questions

  1. Charles L. Maddow says:

    Re: #4 I take off the collar and have them rotate their head looking for willingness to rotate head and lack of parasthesias, a la the Canadian rules. I don’t palpate for tenderness. If they had tenderness that’s why I imaged them in the first place and I don’t expect it to go away simply because they were imaged.

  2. Nicholas Maldonado says:

    Re #4- This brings upon an interesting question which I am not sure has been rigorously answered which is: what is the risk of clinically important spinal cord injury or Cervicoligamentous injury in a patient with a negative CT after blunt neck trauma? It appears that there are several mechanisms in the literature for which people screen for this including MRI, immediate vs delayed flexion-extension radiographs (which after a personal review appear to have extremely low clinical utility), dynamic CT, and leaving on a collar for outpatient F/U with a spine specialist. I think the most important questions for EPs include what the incidence is of Cervicoligamentous injury or spinal cord injury with negative CT, and what are risk factors (possibly mechanism of injury, age, etc) and clinical factors (I.e possibly severity of neck pain after collar removal, focal neuro symptoms, etc) that alter the probability of having this. I’m interested to see what your review might hold, as I had been personally frustrated with the paucity of current high quality data. This may be an interesting question to answer in the future.

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