Spinal Cord Trauma and Related Diseases Treatment & Management

  • Author: Francisco de Assis Aquino Gondim, MD, MSc, PhD; Chief Editor: Stephen A Berman, MD, PhD, MBA   more...
 
Updated: Aug 12, 2011
 

Medical Care

Discussing each therapeutic strategy separately is difficult because of the diversity of etiologic processes and manifestations. Instead, this article focuses on general guidelines for the management of patients with spinal cord injury (SCI), especially after traumatic SCI.

Important advances in the medical and surgical management of SCI have occurred in recent years. The primary goal is to limit secondary injury.

  • Spinal stabilization, immobilization, and management of hemodynamic and/or autonomic disturbances are crucial in the acute injury phase, while management of gastrointestinal (eg, ileus, constipation, ulcers), genitourinary (eg, urinary tract infections, hydronephrosis), dermatologic (eg, bed sores), and musculoskeletal (eg, osteoporosis, fractures, overuse syndromes, acute and chronic pain) complications is the long-term goal.
  • If trauma is suspected, stabilize the head and neck manually or with a collar. Move the patient very carefully using the logroll technique to prevent lateral displacement. A spine board with restraints is recommended, but other items, such as head blocks, pillows, and cushions, may be useful.
  • Emergent radiation therapy may be required for metastatic disease. For spinal tumors causing mass effect, a few anecdotal protocols use dexamethasone in high doses of 10-100 mg IV followed by 6-10 mg IV q6h for 24 hours, potentially tapered intravenously or orally over 1-3 weeks.
  • A multicenter study reported reduced mortality rates after SCI with high doses of methylprednisolone administered within 8 hours, and this practice has been considered the standard of care in the United States.[5] However, this remains controversial because of increased risk of gastric bleeding and wound infection. The Third National Acute Spinal Cord Injury Randomized Controlled Trial (NASCIS III) revealed that patients with acute spinal cord injury who receive methylprednisolone within 3 hours of injury should be maintained on therapy for 24 hours. When methylprednisolone is initiated 3-8 hours after injury, patients should be maintained on therapy for 48 hours.[6]
  • A small, 2-year, prospective study from Japan with 79 patients found no benefit from acute treatment and reported a higher incidence of pneumonia in the treated group.[7] Several societies, including the Canadian Association of Emergency Physicians are no longer recommending this protocol as a standard of care for acute spinal cord injury management.
  • GM1 ganglioside, naloxone, and tirilazad had no benefit in a multicenter trial despite beneficial results in experimental animals.
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Surgical Care

Early surgery to remove damaging bone, disc, and foreign bodies is controversial unless severe compromise of the canal is clear. Surgical interventions in the subacute phase (ie, 24-72 h later) have yielded unsatisfactory results because most tissue damage is irreversible by then.

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Consultations

In the acute phase, severe SCI, especially after high lesions, requires the attention of a specialized trauma team.

For long-term management, consultations with many specialists are often necessary because of the multiple organ complications that follow SCI.

Specifically, referral to a urologist, a gastroenterologist, a psychiatrist, a plastic surgeon, a dermatologist, and a pain management specialist may be necessary. Rehabilitation specialists such as physiatrists or neurologists become involved after the immediate hospitalization.

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Diet

Dietary changes to maximize bowel function may be indicated. Calcium and vitamin D supplementation should be considered to avoid osteoporosis.

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Activity

Early rehabilitation is encouraged once stabilization of the spine has been achieved.

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Contributor Information and Disclosures
Author

Francisco de Assis Aquino Gondim, MD, MSc, PhD  Associate Professor of Neurology, Department of Neurology and Psychiatry, St Louis University School of Medicine

Francisco de Assis Aquino Gondim, MD, MSc, PhD is a member of the following medical societies: American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and Movement Disorders Society

Disclosure: Nothing to disclose.

Coauthor(s)

Florian P Thomas, MD, MA, PhD, Drmed  Director, Spinal Cord Injury Unit, St Louis Veterans Affairs Medical Center; Director, National MS Society Multiple Sclerosis Center; Director, Neuropathy Association Center of Excellence, Professor, Department of Neurology and Psychiatry, Associate Professor, Institute for Molecular Virology, and Department of Molecular Microbiology and Immunology, St Louis University School of Medicine

Florian P Thomas, MD, MA, PhD, Drmed is a member of the following medical societies: American Academy of Neurology, American Neurological Association, American Paraplegia Society, Consortium of Multiple Sclerosis Centers, and National Multiple Sclerosis Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Stephen A Berman, MD, PhD, MBA  Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Howard S Kirshner, MD  Professor of Neurology, Psychiatry and Hearing and Speech Sciences, Vice Chairman, Department of Neurology, Vanderbilt University School of Medicine; Director, Vanderbilt Stroke Center; Program Director, Stroke Service, Vanderbilt Stallworth Rehabilitation Hospital; Consulting Staff, Department of Neurology, Nashville Veterans Affairs Medical Center

Howard S Kirshner, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, American Heart Association, American Medical Association, American Neurological Association, American Society of Neurorehabilitation, National Stroke Association, Phi Beta Kappa, and Tennessee Medical Association

Disclosure: Nothing to disclose.

Selim R Benbadis, MD  Professor, Director of Comprehensive Epilepsy Program, Departments of Neurology and Neurosurgery, Tampa General Hospital, University of South Florida College of Medicine

Selim R Benbadis, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Sleep Medicine, American Clinical Neurophysiology Society, American Epilepsy Society, and American Medical Association

Disclosure: UCB Pharma Honoraria Speaking, consulting; Lundbeck Honoraria Speaking, consulting; Cyberonics Honoraria Speaking, consulting; Glaxo Smith Kline Honoraria Speaking, consulting; Pfizer Honoraria Speaking, consulting; Sleepmed/DigiTrace Honoraria Speaking, consulting

Chief Editor

Stephen A Berman, MD, PhD, MBA  Professor of Neurology, University of Central Florida College of Medicine

Stephen A Berman, MD, PhD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Neurology, and Phi Beta Kappa

Disclosure: Nothing to disclose.

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A T1-weighted MRI that depicts a lesion with high signal enhancement inside the cervical spinal cord. This type of signal enhancement is consistent with blood and is most commonly observed secondary to cord trauma.
 
 
 
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