J Korean Soc Spine Surg.  2018 Jun;25(2):81-89. 10.4184/jkss.2018.25.2.81.

Initial Assessment and Management of Patients with Spinal Cord Injury

• Seo JY
• Yoo J

• KMID: 2421615
• DOI: http://doi.org/10.4184/jkss.2018.25.2.81

Abstract

STUDY DESIGN: Literature review.
OBJECTIVES
To summarize the most up-to-date information on the initial management and neurological examination of patients with spinal cord injury (SCI). SUMMARY OF LITERATURE REVIEW: Secondary injuries result from acute pathophysiological processes such as bleeding, hypoperfusion, inflammation, necrosis, and apoptosis around neural elements that initially survive a mechanical injury.
MATERIALS AND METHODS
Orthopedic surgeons must be familiar with the anatomy of the spinal cord and the initial management of a patient with SCI. A detailed neurological examination in accordance with the International Standards for the Neurological Classification of Spinal Cord Injury is a prerequisite. It is important to distinguish between spinal shock and neurogenic shock, which are characteristic phenomena in patients with SCI.
RESULTS
Rapid realignment of the spine and proper medical management to avoid hypoperfusion are important in the overall care of a patient with SCI.
CONCLUSIONS
Patients with SCI should be managed and treated properly to enable them to return home and to their work as soon as possible.

Keyword

Spinal cord injury; Shock; Motor; Sensory; Reflex

MeSH Terms

Apoptosis
Classification
Hemorrhage
Humans
Inflammation
Necrosis
Neurologic Examination
Orthopedics
Reflex
Shock
Spinal Cord Injuries*
Spinal Cord*
Spine
Surgeons

Figure

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  Fig. 1. Worksheet for an imaginary patient with a complete spinal cord injury.

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  Fig. 2. Worksheet for an imaginary patient with a spinal cord injury whose American Spinal Injury Association (ASIA) impairment scale score is B.

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  Fig. 3. Worksheet of an imaginary patient with a spinal cord injury whose American Spinal Injury Association (ASIA) impairment scale score is C. This differs from Figure 2 in that the motor strength is grade 1 at the T1 level.

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  Fig. 4. Worksheet of an imaginary patient with a spinal cord injury whose American Spinal Injury Association (ASIA) impairment scale score is D. In regions where there is no myotome to test, the motor level is presumed to be the same as the sensory level.

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