Management of spinal injuries in a patient with polytrauma

Abstract

Acute spinal cord injury primarily affects young otherwise healthy people and is a major cause of patient morbidity and a source of significant health care expenditure. The priority in the management of spinal injury in a patient with polytrauma is to minimize secondary mechanical or physiological insults to the spinal cord. Identification of spinal injuries during initial trauma evaluation is challenging, as patients often have a reduced level of consciousness due to other injuries or are under the influence of sedative and/or analgesic medication. The management of suspected spinal cord injury in patients with polytrauma involves early immobilization of the whole spine and the institution of measures to prevent secondary injury from hypoxia, hypoperfusion or further mechanical disturbance. All spinal injuries should be considered unstable and incomplete until proven otherwise. Careful and informed neurological assessment, together with appropriate plain radiography, will identify the majority of spinal injuries. Early surgical decompression should be considered. Improvements in motor vehicle safety and traffic regulations can result in a marked reduction in spinal cord injury due to motor vehicle accidents with significant reduction in mortality attributable to spinal injury. A robust system of care is the best assurance of good health outcomes and reasonable health for people with spinal cord Injury.