Question about SCI

Specialties Neuro

Published

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!

Up Vote Up Vote ×
Specializes in Trauma/Critical Care.

if it's a cervical injury , am i right it is stabilized with traction initially, then probably to surgery and/or halo vest?

realignment of the spine using a rigid brace or axial traction is usually done as soon as possible to stabilize the spine and prevent additional damage. injury to the spinal cord at or above the c3, c4, and c5 segments (which supply the phrenic nerves leading to the diaphragm), can stop breathing. intubation is done to protect the airway.sometimes surgery may be necessary to remove fragments of bones, foreign objects, herniated disks or fractured vertebrae (aeb by mri result) if there is compression to the spine cord.

what about a t-spine problem?

log rolling, spine precaution, steroids, traction, and surgery if spine compression is present.

what is done initially in the ed or in the first day to stabilize it?

when injury occurs and for a period of time thereafter, the spinal cord responds by swelling. treatment starts with steroid drugs ( methylprednisolone (medrol) is a treatment option for an acute spinal cord injury) which, in my experience is usually initiated in the er (sometimes even in the field). rigid neck brace and spine precaution are implemented. due to the nature of the er (lack of special bed/equipment) for traction, it is usually initiated in icu.

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?

that is an interesting question...in my experiece,depending on the severity of the sci , i had seen neurosugeons intubate and sedate their patients, in order to prevent further damage, until surgery. it would be interested to read about how others usually deal with this type of situation.

take care

Up Vote Up Vote ×

Thank you so much for your helpful reply!

I have found a lot of conflicting info about steroid therapy. Several (apparently reputable) websites (trauma.org and Paralyzed Veterens of America) indicate EBP is NOT to give steroids...little benefit and a number of added risks. I see you mention this, so I am thinking it is still being done in practice and perhaps for good reason. Any thoughts on that???

Up Vote Up Vote ×
Specializes in Trauma/Critical Care.
Thank you so much for your helpful reply!

I have found a lot of conflicting info about steroid therapy. Several (apparently reputable) websites (trauma.org and Paralyzed Veterens of America) indicate EBP is NOT to give steroids...little benefit and a number of added risks. I see you mention this, so I am thinking it is still being done in practice and perhaps for good reason. Any thoughts on that???

Hi more,

The use of steroid to tread SCI is still the standard of care for tx of acute SCI (within 8hrs of injury), in my area (LA, California). There are many studies disclaiming its benefits in the acute phase...but there are also many studies supporting it. It all comes down to physician's preference. Because it is still considered the standard of care to treat SCI, many providers will still prescribed (despite the new EBP), for fear of being sue over not prescribing it.

I found an interesting discussion about the subject in the link below...

http://uncleharvey.com/index.php/forums/viewthread/611/

Hope it Helps...

Keep On Learning.

Up Vote Up Vote ×

Very interesting! Thanks for the resource and discussion!

Up Vote Up Vote ×
+ Add a Comment