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

  • Respiratory support.

C4 injury 150mls tidal volume( scalene, SCM )

Pulmonary toilet preventing subacute failure

  • Haemodynamics

T6 or above analagous to sympathectomy. Volume

Expansion and beta or alpha/beta agonists. Swan-Ganz.

  • Immobilisation


  • Pharmacological Rx

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

  • Gangliosides? See paper

  • Stabilisation

Need pre-traction MRI?

Disc herniation with t raction for facet dislocation very rare therefore apply traction early

  • Post acute support

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


Braken MB , Shepard MJ et al


A randomized, controlled trial of methylprednisolone or naloxone in the treatment of spinal cord injury: results of the second NASCIS


N Engl J Med 1990; 322: 405-1411


Prospective randomised double blind. 487 pts. Methylpred vs naloxone vs placebo. Primary outcomes negative


Secondary post hoc analysis showed difference between treatment< or> 8hours Random cut off point. Cannot be considered as Class 1 evidence.

Small differences in neurological function cannot be ascribed clinincal significance. Neurologic data not released for independent analysis. Results have never been reproduced.

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