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Traumatic spinal cord injury — Clinical Guidelines

Overview

Traumatic spinal cord injury (TSCI) results in significant long-term disability, affecting neurological function and necessitating comprehensive management of secondary complications 1.

Diagnosis

Key Diagnostic Criteria: Neurological examination using the American Spinal Injury Association (ASIA) Impairment Scale 3.

Recommended Tests:

- Computed tomography (CT) scans for initial assessment 4. - Upright radiographs to evaluate instability in thoracolumbar fractures 4. - MRI for detailed spinal cord and soft tissue evaluation 5.

Grading: ASIA Impairment Scale (AIS) to assess severity of neurological injury 3.

Management

First-Line Treatments:

- Early surgical stabilization for unstable fractures 6. - Airway management using video laryngoscopy to minimize cervical spine movement 7.

Adjunctive Treatments:

- Multidisciplinary rehabilitation programs focusing on physical, occupational, and psychological support 1. - Management of polypharmacy with medication self-management tools to address secondary complications 2 8.

Specific Interventions:

- Monitoring organ dysfunction using SOFA score in patients with TSCI above T6 to guide prognosis and treatment 5.

Special Populations

Elderly: Higher prevalence of polypharmacy and associated complications; tailored medication management strategies are crucial 8.

Pediatrics: Not directly addressed in provided abstracts.

Comorbidities: Management of concurrent conditions through comprehensive polypharmacy oversight 2 8.

Key Recommendations

Utilize a combination of CT scans and upright radiographs for accurate assessment of thoracolumbar fractures to guide management decisions (Evidence: Moderate 4).

Implement multidisciplinary rehabilitation programs early post-injury to improve long-term functional outcomes (Evidence: Expert opinion 1).

Employ video laryngoscopy for airway management in patients with unstable cervical spine injuries to minimize neurological risk (Evidence: Moderate 7).

Monitor organ dysfunction using the SOFA score in patients with TSCI above T6 to predict mortality and guide intensive care interventions (Evidence: Moderate 5).

Support medication self-management in individuals with TSCI to effectively handle polypharmacy and secondary complications (Evidence: Weak 2 8).

References

1 Akavian I, Cohen B, Gendler S, Almog O, Besor O, Radomislensky I et al.. Long-Term Disability After Traumatic Spinal Injuries: A Military Retrospective Study. Military medicine 2025. link 2 Cadel L, Cimino SR, Bradley-Ridout G, Hitzig SL, Packer TL, McCarthy LM et al.. A scoping review of medication self-management intervention tools to support persons with traumatic spinal cord injury. PloS one 2023. link 3 Paker N, Soluk Özdemir Y, Buğdaycı D, Çelik B, Bölükbaş Y. Prevalence and predictors of polypharmacy among community-based individuals with traumatic spinal cord injury. The journal of spinal cord medicine 2023. link 4 Laurita J, Brant JE, Degener-O'Brien K, Smith S, Godoy A, Radoslovich SS et al.. Utility of upright radiographs in traumatic thoracolumbar fracture management. BMC musculoskeletal disorders 2022. link 5 Esmorís-Arijón I, Galeiras R, Montoto Marqués A, Pértega Díaz S. Organ dysfunction as determined by the SOFA score is associated with prognosis in patients with acute traumatic spinal cord injury above T6. Spinal cord 2022. link 6 Yli-Hankala A, Chew MS, Olkkola KT, Rehn M, Sverrisson KÖ, Møller MH. Clinical practice guideline on spinal stabilisation of adult trauma patients: Endorsement by the Scandinavian Society of Anaesthesiology and Intensive Care Medicine. Acta anaesthesiologica Scandinavica 2021. link 7 Holmes MG, Dagal A, Feinstein BA, Joffe AM. Airway Management Practice in Adults With an Unstable Cervical Spine: The Harborview Medical Center Experience. Anesthesia and analgesia 2018. link 8 Guilcher SJT, Hogan ME, Calzavara A, Hitzig SL, Patel T, Packer T et al.. Prescription drug claims following a traumatic spinal cord injury for older adults: a retrospective population-based study in Ontario, Canada. Spinal cord 2018. link 9 Stern LC, Moore TA. Nail gun injury to the sacrum: case report and review of the literature. Spine 2011. link 10 Anderson S, Biros MH, Reardon RF. Delayed diagnosis of thoracolumbar fractures in multiple-trauma patients. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine 1996. link 11 Chandler DR, Nemejc C, Adkins RH, Waters RL. Emergency cervical-spine immobilization. Annals of emergency medicine 1992. link81743-3) 12 Umbach I, Heilporn A. Evolution of post-traumatic cervical syringomyelia: case report. Paraplegia 1988. link 13 Bernad PG, Perlo VP. Horner syndrome with causalgia. Neurology 1980. link 14 Owen R, Maxie LL. Repair of fractured dens of the axis in a foal. Journal of the American Veterinary Medical Association 1978. link

Traumatic spinal cord injury