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Cervical spinal cord injury

Definition
Cervical spinal cord injury refers to a complete or partial loss of motor and/or sensory function due to an acute trauma to the cervical spinal cord.
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Pathophysiology
Cervical spinal cord injury is mainly due to accidental falls and motor vehicle accidents/transport injuries.
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Disease course
Clinical manifestations include complete or incomplete loss of all movements and/or sensation and may result in respiratory failure, cardiovascular complications, multiple organ failure, and death.
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Prognosis and risk of recurrence
Cervical spinal cord injury is associated with a 30-day mortality of 9.4%.
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Key sources
The following summarized guidelines for the evaluation and management of cervical spinal cord injury are prepared by our editorial team based on guidelines from the American Association of Neurological Surgeons (AANS/CNS 2013).
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Guidelines

1.Screening and diagnosis

Indications for testing: triage patients with potential spinal injury at the scene to determine the need for immobilization during transport.
B
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2.Classification and risk stratification

Severity grading: use the American Spinal Injury Association (ASIA) international standards for neurological and functional classification of spinal cord injury as the preferred neurological examination tool for the assessment and care of patients with acute spinal cord injury.
B

3.Diagnostic investigations

Evaluation of asymptomatic patients: avoid radiographic evaluation of the cervical spine 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 ROM examination.
D

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  • Evaluation of symptomatic patients

  • Evaluation of obtunded patients

  • MRI

4.Medical management

Indications for cervical spine immobilization
Implement spinal immobilization in all trauma patients with a cervical spine or spinal cord injury or with a mechanism of injury having the potential to cause cervical spinal injury.
B
Avoid spinal immobilization in trauma patients who are awake, alert, 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.
D

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  • Choice of cervical immobilization device

  • Management of awake patients with normal imaging

  • Management of obtunded patients with normal imaging

  • Expeditious transport to specialized centers

5.Surgical interventions

Early closed reduction
Perform early closed reduction of cervical spinal fracture/dislocation injuries with craniocervical traction for the restoration of anatomic alignment of the cervical spine in awake patients.
B
Avoid closed reduction in patients with an additional rostral injury.
D

6.Specific circumstances

Patients with penetrating trauma: avoid implementing spinal immobilization in patients with penetrating cervical trauma because of increased mortality from delayed resuscitation.
D

7.Follow-up and surveillance

Indications for specialist referral: involve physicians trained in the diagnosis and management of spinal injuries to decide on further management in patients in whom there is a high clinical suspicion of injury yet have a normal high-quality CT imaging studies.
B