Acute Spinal Cord Injury: What Matters

Oli covers the initial management of patients with traumatic cervical spinal cord injury. He covers the neurological assessment – how and why we do the ASIA or ISNCSCI Exam and why it matters. It’s not always straight forward, but getting a motor and sensory level and determining if a patient has perianal sensation and voluntary anal contraction can be really helpful prognostically.

The importance of avoiding hypoxia, including ways to manage an airway in this context are then discussed.

Oli then talks blood pressure targets – still a controversial area, but aiming for a MAP > 85 mmHg may really help. Hypotension definitely doesn’t help.

Timing of surgery is another hot topic in acute SCI. Low quality evidence suggests surgery in <8 hours of injury improves outcomes, but is this true and achievable? There are many potential benefits in doing surgery early, but it requires the whole healthcare system to work together to make it happen. The age-old topic of steroids in SCI is touched on; nothing new here, with most centres still avoiding methyl prednisolone.

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