Abstract

Failure to recognize spinal column or spinal cord injuries, or improper treatment of them, can have catastrophic and often irreversible neurologic consequences. Although the initial assessment is often shared with emergency care personnel, an orthopaedic surgeon's perspective can elevate the priority of spinal care to the level that is warranted. An accurate early appraisal, including complete neurologic assessment, is critical. All aspects of emergent care, including optimal immobilization precautions, resuscitation, and choice of imaging modalities, should be systematically reviewed, and practice guidelines should be adopted by each institution. Increased vigilance is required in patients with underlying ankylosing spinal conditions. The use of CT in the symptomatic patient is established, but the use of cervical MRI in the obtunded individual is contentious. By informing decisions around appropriate preliminary treatment, particularly for persons with neurologic deficits or those at high risk for developing neurologic impairment, long-term outcomes can be optimized.

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Publisher Full Text

Authors

Schouten R, Albert T, Kwon BK

Institution

Combined Neurosurgical and Orthopaedic Spine Program, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.

Source

The Journal of the American Academy of Orthopaedic Surgeons 20:6 2012 Jun pg 336-46

MeSH

Cervical Vertebrae
Dislocations
Emergency Medical Services
Humans
Hypotension
Magnetic Resonance Imaging
Physical Examination
Shock, Traumatic
Spinal Cord Injuries
Spinal Injuries
Spondylitis, Ankylosing

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

22661563