Early assessment and emergency management of spinal injuries

Introduction

The basic principles of trauma management are careful, thorough, and immediate initial (early) assessment, which provides a good foundation for further comprehensive treatment. In the case of spinal trauma patients, the importance of an accurate early assessment is to prevent permanent neurological impairment from occurring.

Inappropriate management of spinal trauma patients can easily lead to more serious consequences, so experimental management measures are obviously less appropriate in early assessment. Therefore, most of the current treatment management measures and clinical practice guidelines are based on Level II, III, and IV evidence from existing large samples of clinical studies.

Field confirmation

High-energy injuries in young people are the most common cause of spinal or spinal cord injuries, such as motorcycle crashes and high-risk occupations. Low-energy injuries in elderly patients are the second most common cause. Elderly patients are prone to fragility fractures at low energy due to osteoporosis combined with spinal stiffness. Both physicians and patients should be alert to the fact that in some specific cases the symptoms of spinal injuries are easily masked by other injuries, such as patients with closed cranial and facial injuries, which are often combined with cervical spine injuries when the patient suffers violence to the head. In addition, if a single-segment spinal fracture is found, other spinal cones need to be alerted to the fracture. A recent study suggests that CT scans of 492 patients with single-segment spinal injuries revealed a fracture incidence of about 19% in the non-adjacent phase.

Protection of the injured spine and spinal cord should begin at the scene of the accident. Statistics show that approximately 25% of patients who suffer a spinal injury at the scene of a car accident are not properly assisted, resulting in irreversible neurological impairment later in life. Proper handling and immobilization can effectively protect the neurological function of patients with spinal injuries and prevent further deterioration of neurological damage. Current recommendations include strong cervical brace immobilization, strong lateral support, and keeping the spinal axis stable during transport to avoid further injury.

In young children, because the head is usually larger than the body, placing the body on a flat surface can easily lead to anterior cervical flexion, which can exacerbate any possible cervical spine injury. Therefore, when spinal injuries occur in this group of patients, the cervical spine must be placed in a neurologically functional position, such as a pre-set depression in the occipital area on the transfer plate or a cushion in the trunk position to keep the neck slightly posteriorly extended.

If a patient with ankylosing spondylitis has a spinal fracture, immobilization of the patient should take into account the pre-existing spinal deformity, and patients with a stiff spine can have a pad placed on the head to maintain the curvature of the spine if necessary. Overcorrection of the posterior extension of the cervical spine may further exacerbate an existing extension-distraction subluxation with serious consequences.

Improper braking can lead to severe disability: cervical braces may increase intracranial and cerebrospinal fluid pressure and can alter swallowing function, increasing the likelihood of aspiration, so it is important to diagnose neck injuries as soon as possible to allow early release of the brace; spinal stretcher plates are often incorrectly thought of as tools to provide spinal stability, but in fact, they are used only during extrication and transport The orthopedic surgeon should transfer the patient from the stretcher board to an appropriate bed as soon as possible because lying on such a board may impair respiratory function and may cause more severe decubitus ulcers when lying on the board for long periods of time.

Summary

For patients with high suspicion of spinal cord injury, systematic assessment by physicians at the resuscitation site and meticulous care can effectively reduce the probability of disability in patients with spinal cord injury. Once a patient with a spinal injury has been effectively braked, an assessment of the patient's systemic condition, including a full neurological assessment, should begin immediately. The assessment of patients with underlying ankylosing spondylitis needs to be particularly careful, as these patients can sustain fractures in the spinal region even with minimal trauma. CT is necessary for the evaluation of patients with symptomatic spinal injuries, but MRI is controversial in patients with impaired consciousness. The effectiveness of neuroprotective drugs and surgical treatments that are already available needs to be confirmed by more clinical studies.