Question about SCI

[More2Learn]

I have a question about an acute SCI. If it's a cervical injury , am i right it is stabilized with traction initially, then probably to surgery and/or halo vest? If so, how soon is surgery done? If there is impingement of the cord, wouldn't it be done ASAP (that day)? What about a T-spine problem? What is done initially in the ED or in the first day to stabilize it? I know we are trying to get people off backboards ASAP...if the person is alert and cooperative is it enough to just have them on bed rest with logrolling? What if they are uncooperative...are there any other ways of stabilizing the spine before going to surgery? Thanks for any help from those who work in the field!

[Rob72, ASN, RN]

I have a question about an acute SCI. If it's a cervical injury , am i right it is stabilized with traction initially, then probably to surgery and/or halo vest? If so, how soon is surgery done? If there is impingement of the cord, wouldn't it be done ASAP (that day)? What about a T-spine problem? What is done initially in the ED or in the first day to stabilize it? I know we are trying to get people off backboards ASAP...if the person is alert and cooperative is it enough to just have them on bed rest with logrolling? What if they are uncooperative...are there any other ways of stabilizing the spine before going to surgery? Thanks for any help from those who work in the field!

• Cervical injury(suspected) initially stabilised with C-collar.
  
• Maintained in collar/on board until cleared by radiology.
  
• If SCI, management may include varying forms of fixation, and will frequently wait for reduction of swelling before final surgical intervention is decided upon. (Compression from swelling may result in self-resolving deficits)
  

I'm not a floor nurse, and its been quite a few years since I had a new SCI admit, so someone more current may elucidate. Your last questions about cooperative/uncooperative are pretty broad, and very situationally dependant.

[ZippyGBR, BSN, RN]

acute necks get an aspen or miami collar if they aren't in traction - regardless of what method you'd do a 5 person log roll to turn for pressure relief.

an acute thoraco-lumbar injury you might put a TLSO brace on if it was felt to be clinically prudent otherwise they are nursed on flat bedrest and 4 person log rolled to turn / 30 degree tilted regularly if they have deficit - or as required if they are intact . I have sen cases where we have put people into TLSO braces earlier than we might have otherwise because they were none complaint with bedrest

it is prudent to wait for 'spinal shock' to resolve to determine exactly what the deficit is before jumping to fix people - there are also sometimes things to weigh up s over fixation such as the reduced flexibility of a fixed back vs. the flexibility if the fracture is allowed to heal by bed rest +/- traction.