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Lumbosacral Spine Acute Bony Injuries Medication

  • Author: Federico C Vinas, MD; Chief Editor: Sherwin SW Ho, MD  more...
Updated: Sep 30, 2013

Medication Summary

If the patient arrives at the treating facility within 8 hours of the initial injury and has evidence of a spinal cord injury, 30 mg/kg of methylprednisolone should be given as a slow bolus within the first hour, followed by an infusion of 5.4 mg/kg each hour for the next 23 hours. The use of large doses of steroids can induce stress ulcers and gastritis; therefore, prophylaxis with H2 blockers and/or other antacids should be implemented. Note: This regimen of methylprednisolone is contraindicated in pregnant patients.



Class Summary

Steroids—in particular, methylprednisolone—have been proven in clinical trials to reduce the formation of free oxygen radicals and improve clinical outcomes following spinal cord injuries.

Related Medscape Reference topics:

Corticosteroid Injections of Joints and Soft Tissues

Corticosteroid-Induced Myopathy

Epidural Steroid Injections

Related Medscape resources:

Resource CenterSpinal Disorders

Specialty SiteOrthopaedics

Methylprednisolone (Medrol, Solu-Medrol, Depo-Medrol)


Several studies have demonstrated that if started within 8 h of injury, this high-dose steroid protocol can improve outcome in patients with a spinal cord injury.



Class Summary

Pain control is essential to quality patient care. Analgesics ensure patient comfort, promote pulmonary toilet, and have sedating properties, which are beneficial for patients who have sustained trauma.

Related Medscape Reference topic:

Opioid Toxicity

Related Medscape resources:

Resource CenterAdverse Drug Events Reporting

Resource CenterOpioids: A Guide to State Opioid Prescribing Policies

Resource CenterPain Management: Pharmacologic Approaches

Resource CenterSpinal Disorders

Morphine (Duramorph, Astramorph, MS Contin)


In the acute phase following acute lumbar bony injury, patients are severely incapacitated by severe pain. Any movement, coughing, or straining produces severe pain. Morphine sulfate is the most-used drug and can be given via IV, IM, or IV pump on demand (PCA pump). Some physicians prefer to use codeine because they consider it less sedative.


Stool Softeners

Class Summary

Patients with spinal fractures are at risk of developing constipation and fecal impaction. In these patients, straining causes severe pain. In addition, patients with acute spinal fractures require narcotic analgesics for pain control.

Related Medscape Reference topics:


Intestinal Motility Disorders

Opioid Toxicity

Related Medscape resources:

Resource CenterFracture

Resource CenterOpioids: A Guide to State Opioid Prescribing Policies

Resource CenterPain Management: Pharmacologic Approaches

Resource CenterSpinal Disorders

Docusate (Colace, Dialose, Surfak)


For patients who should avoid straining during defecation. Allows incorporation of water and fat into the stool, causing stool to soften.


H2 Blockers, Antihistamine

Class Summary

Antihistamine H2 blockers are reversible competitive blockers of histamine at the H2 receptors, particularly those in the gastric parietal cells, where they inhibit acid secretion. The H2 antagonists are highly selective, do not affect the H1 receptors, and are not anticholinergic agents.

Related Medscape Reference topics:

Necrotizing Enterocolitis

Antihistamine Toxicity

Ranitidine (Zantac)


Inhibits histamine stimulation of the H2 receptor in gastric parietal cells, which, in turn, reduces gastric acid secretion, gastric volume, and hydrogen ion concentrations.

Contributor Information and Disclosures

Federico C Vinas, MD Consulting Neurosurgeon, Department of Neurological Surgery, Halifax Medical Center

Federico C Vinas, MD is a member of the following medical societies: American Association of Neurological Surgeons, American College of Surgeons, American Medical Association, Florida Medical Association, North American Spine Society, Congress of Neurological Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

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

Disclosure: Received salary from Medscape for employment. for: Medscape.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Chief Editor

Sherwin SW Ho, MD Associate Professor, Department of Surgery, Section of Orthopedic Surgery and Rehabilitation Medicine, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine

Sherwin SW Ho, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Arthroscopy Association of North America, Herodicus Society, American Orthopaedic Society for Sports Medicine

Disclosure: Received consulting fee from Biomet, Inc. for speaking and teaching; Received grant/research funds from Smith and Nephew for fellowship funding; Received grant/research funds from DJ Ortho for course funding; Received grant/research funds from Athletico Physical Therapy for course, research funding; Received royalty from Biomet, Inc. for consulting.

Additional Contributors

Andrew D Perron, MD Residency Director, Department of Emergency Medicine, Maine Medical Center

Andrew D Perron, MD is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

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Lateral plain radiograph. This image shows an L3 compression fracture.
A computed tomography scan with sagittal reconstructions allows better visualization of the compression fracture.
Sagittal T1-weighted magnetic resonance imaging study of a professional driver who was in a rollover motor vehicle accident while racing his car. This figure shows a T-10 unstable burst fracture producing severe kyphotic deformity of the spine. The abnormal signal on the vertebral body and the extradural defect represents a subacute hematoma producing spinal cord compression. The patient had severe paraparesis and underwent an emergency operation. The procedure involved an anterolateral retroperitoneal approach with a corpectomy and vertebral reconstruction.
Postoperative plain x-ray film of a professional driver who experienced a burst fracture in a rollover motor vehicle accident while racing his car. This image shows a vertebral reconstruction with the use of a titanium cage filled with bone and the arthrodesis with a Z plate.
Axial computed tomography scan of an athlete who had a hyperextension injury that resulted in disruption of the posterior spinal elements. This patient had compromise of the anterior and middle spinal columns, resulting in an unstable fracture.
Computed tomography scanning with 3-dimensional reconstruction facilitates the assessment of some complex fractures. In this case, the patient experienced a severe compression fracture.
Sagittal computed tomography scan reconstruction of an athlete who had a burst fracture.
Computed tomography scan with coronal reconstruction of an athlete who had multiple compression fractures.
Magnetic resonance image of a young female with a severe unstable fracture of L4. The patient had a partial neurologic deficit and required urgent surgical fixation.
Postoperative radiograph of a patient status post reduction, fusion, and internal fixation of an unstable fracture. Note that the anatomic alignment has been restored.
Sagittal computed tomography scan reconstruction of a young female who had a skydiving accident. The parachute deployed, but the patient landed on concrete and sustained a lower-extremity fracture and a fracture of L1. She was neurologically intact but required an open reduction with a fusion and instrumental fixation of the fracture.
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