Management of Acute Cervical Spinal Cord Injury

BACKGROUND—Spinal cord injury affects approximately 10,000 new persons each year in the United States. Motor vehicle crashes, violence, and falls are the most common causes. The purpose of this review is to provide a rational management strategy for treating acute cervical spinal cord injuries. REVIEW SUMMARY—History-taking in these patients should focus on a few key points. Physical examination consists of determining the level of the lesion by a tailored motor, sensory, and reflex examination. An algorithm for the judicious use of plain radiographs, computed tomography scans, and emergent magnetic resonance imaging is presented. Management goals include protection of uninjured tissue, restoration of reversibly injured tissue, and achieving alignment and permanent spinal stability. The role of early surgery and high-dose steroids are discussed. CONCLUSION—Maximizing neurological function after cervical spinal cord injuries relies on rapid diagnosis and appropriate management. Although prognosis generally remains poor, recent advances in the basic sciences offer hope for the future.