Traumatic Spinal Cord Injuries: An Evidence-based Practice Approach

Kumar N

doi:10.4172/2165-7939.s7-006

Abstract

This article deals with the main issues of management of traumatic spinal cord injury discussing - physiological instability, prognostic determinants of recovery, natural history, care in supine position, mobilization, canal encroachment, cord compression, and indications for surgery. A review of relevant literature has been done including the STASCIS study to try and explore whether early or late surgery for traumatic spinal cord injury is better than conservative management. It reflects the ethos of Active Physiological Conservative Management for these patients at RJ&AH Orthopaedic Hospital. Considering the lack of credible evidence demonstrating superiority of outcome with surgery compared to early active management of the traumatic spinal injury, patients should be encouraged to make an informed choice.

Highlights

The Management of the Traumatic spinal injury has remained controversial since the times of Charles Bell and Astley Cooper
Patients with incomplete cord injuries make significant neurological recovery irrespective of the degree of canal stenosis, canal encroachment, misalignment or cord compression [5,7,15,22] provided both the biomechanical Instability of the spinal column and the Physiological Instability of the spinal cord are well contained by Active Physiological Conservative Management (APCM)
We suggest that it would be better for surgery to be postponed until the blood brain barrier is restored which is likely to take about three weeks following the injury

Summary

Introduction

El Masri, et al [1] demonstrated that with expert, early, simultaneous APCM of the injured spine, spinal cord and all the medical and non-medical effects over 70% of patients with complete motor paralysis but with sparing of pin prick sensation presenting in the first 72 hours of injury recover motor power to ambulate without surgical, pharmacological, cellular or biological intervention. Canal encroachment and cord compression do not prevent neurological recovery and are rarely, individually or in combination the cause of neurological deterioration when patients are adequately managed with APCM.

Results

Conclusion