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Acute Spinal Injuries: Assessment and Management

May 2006

Abstract

Acute spinal cord injuries (ASCIs) remain a devastating consequence of traumatic injuries around the globe. These injuries cause permanent, profound disabilities and lead to changes in lifestyle ranging from employment to marital status. They can also greatly diminish quality of life and decrease life expectancy. The initial hospital charges approach $100,000.1 Lifetime costs range from $525,000-950,000.2, 3 This in turn costs the United States approximately $9 billion per year.4 Early recognition and management of these injuries is essential to minimizing their consequences. It is crucial that emergency physicians anticipate ASCIs and familiarize themselves with skills that prevent, identify, and treat these injuries as they present to the emergency department.

This review offers an up-to-date discussion and an evaluation of the latest approach to blunt trauma patients with potential acute spinal cord injuries. There have been numerous new developments to all four foci of this paper: immobilization, emergency department (ED) clinical spine clearance, imaging modality to evaluate spine injuries, and the treatment of spinal cord injuries if present. Inspired by the success of ED cervical spine clearance criteria, there have been attempts to develop prehospital immobilization criteria. There have been new approaches suggested on how to clinically evaluate ED patients who have been immobilized. The Canadian C-spine Rule (CCR) was recently developed to supplant the National Emergency X-Radiography Utilization Study (NEXUS) low-risk criteria because of their perceived weaknesses when used outside the United States. Within the US, EDs are increasingly using multi-detector computed tomography (MDCT) instead of traditional x-rays as the first imaging modality to evaluate the spine. Perhaps one of the most significant changes is that after the re-evaluation of the National Acute Spinal Cord Studies, high dose methylprednisolone sodium succinate (MPSS) has been downgraded by many organizations from the recommended therapy to a treatment "option." These profound developments require a change in the traditional paradigm used to manage ASCI patients, and this review updates the emergency department approach to them.

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