Spinal Cord Injuries Guidelines

Updated: Nov 01, 2018
  • Author: Lawrence S Chin, MD, FACS, FAANS; Chief Editor: Brian H Kopell, MD  more...
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Guidelines

Guidelines Summary

Guidelines related to spinal cord injuries treatments are focused on avoidance of secondary injury from compressive lesions and hemodynamic instability.

American Association of Neurological Surgeons/Congress of Neurological Surgeons

The 2013 update of the AANS/CNS Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injury include the following recommendations. [57, 58]

Immobilization

Immobilization of trauma patients who are awake, alert, and are not intoxicated; who are without neck pain or tenderness; who do not have an abnormal motor or sensory examination; and who do not have any significant associated injury that might detract from their general evaluation is not recommended.

A combination of a rigid cervical collar and supportive blocks on a backboard with straps is effective in limiting motion of the cervical spine and is recommended.

The longstanding practice of attempted spinal immobilization with sandbags and tape is insufficient and is not recommended.

Spinal immobilization in patients with penetrating trauma is not recommended.

Radiographic assessment

In the awake, asymptomatic patient who is without neck pain or tenderness, who has a normal neurological examination, is without an injury detracting from an accurate evaluation, and who is able to complete a functional range of motion examination; radiographic evaluation of the cervical spine is not recommended.

In the awake, symptomatic patient, high-quality computed tomography (CT) imaging of the cervical spine is recommended.

In the obtunded or unevaluable patient, high-quality CT imaging is recommended as the initial imaging modality of choice. 

Pharmacological therapy

Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is not Food and Drug Administration (FDA) approved for this application. 

Administration of GM-1 ganglioside (Sygen) for the treatment of acute SCI is not recommended.