Spinal Cord Injury - Gavin Jennings 5/10/2002
Non operative management
Prevention of secondary SCI and complications
-Mechanisms postulated include free radical formation, calcium influx, ischaemia, lipid peroxidation, apoptosis
C4 injury 150mls tidal volume( scalene, SCM )
Pulmonary toilet preventing subacute failure
T6 or above analagous to sympathectomy. Volume
Expansion and beta or alpha/beta agonists. Swan-Ganz.
As per ATLS/ APLS
NASCIS 2 AND 3 recommend methylpred. (see papers) Give 30mg/kg loading within 8 hours, then 5.4 mg/kg/ hour for 24 hours if commenced < 3hours 48 hours if commenced 3-8 hours No benefit if started later than 8 hours
Need pre-traction MRI?
Disc herniation with t
raction for facet dislocation very rare
therefore apply traction early
Nutrition, thromboembolic prevention, integument Breakdown, prevention of pyrexia ( causes 2ary SCI)
Operative management
Review: Spine Vol 26 (24AS) 2001
Class
III data to support a recommendation for urgent reduction of bilateral locked facets with incomplete tetraplegia
Limited Class III to support
recommendation for urgent decompression in patient with deteriorating function
Vaccaro et al
Neurological Outcome of Early v Late Surgery for Cervical Spinal Cord Injury
Spine Vol22 No 22 pp2609-2613
<72hrs v> 100hrs
No difference
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