In this section
Spinal cord injury should be suspected in any child who has:
The patient must be adequately immobilised, for example, on a spinal board with a cervical collar and head immobiliser (
see cervical spine assessment clinical practice guideline). Any assessment of the back, or of patient movement, must be accomplished by logrolling. Recent figures suggest that up to 50% of patients with spinal cord injury will have at least moderate head injury.
In all aspects of trauma management,
the primary survey is the first priority
The most immediate threats to life and
spinal cord function of patients with spinal cord injury are always
hypoxia and hypotension.
Neurogenic shock should not be
confused with Spinal Shock
Spinal shock is the reversible dysfunction of the spinal cord associated with injury
Examination of neurologic impairment is done as part of the secondary survey.
Partial spinal cord injury:
Complete spinal cord injury:
Cauda equine lesions
Patients requiring more than 40 ml/kg of fluid replacement, and having a low CVP, must be assumed to have other injuries causing blood loss.
In all patients with suspected spinal cord injury, the spine should be x-rayed.
Spinal cord injury without radiographic abnormality is present when there are objective signs of myelopathy as a result of trauma, with no evidence of fracture or ligamentous instability on plain x-rays or CT.
Because of these delayed
presentations, all children with symptoms of any neurologic deficit
should be treated as potential spinal cord injuries.
Most of the treatment available for spinal cord injuries is supportive. The breathing and circulation must be supported as needed.
Specific treatment of the spinal cord lesion is controversial.
Four substances have been studied in prospective, randomised trials
All studies to date have excluded children under 13 years of age.
Methylprednisolone Administration in
cervical spine assessment clinical practice guideline
2. Tirilazad and Naloxone
3. GM-1 ganglioside
Once the patient has been stabilised and investigated, transfer to a spinal cord injury unit should be expedited. Consultation with the spinal service should be made early.