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Chiropractic Research Review

Improving Management of Spinal Cord Injuries

Traumatic cervical spinal cord injury (CSCI) can vary from partial to complete loss of upper and lower limb function. Because each cervical segmental level provides a unique functional capacity, subsequent loss of an additional motor segment may cause an alteration in function.

Despite early recognition, rapid transport, cardiopulmonary resuscitation, and spinal immobilization in the setting of an acute CSCI, secondary neurologic deterioration usually occurs. Even with these early measures to limit the damage of CSCI, the roots of delayed neurologic deterioration are not clearly understood.

This study identifies and classifies the causes of secondary neurologic deterioration in patients with CSCI. One hundred eighty-two patients with complete spinal cord injury were identified. Researchers investigated their demographics; mechanism of injury; American Spinal Cord Injury Association (ASIA) level on admission and during hospital stay; onset of ascension; blood pressure; hemoglobin; febrile episode; heparin administration; and the timing of operation and traction. Radiographs were reviewed with attention to fracture type and neurologic and vascular injuries.

Results showed that 12 of 186 patients (6.0%) with ASIA Grade A complete spinal cord injury had neurologic deterioration during the first 30 days after injury. No patients with penetrating injuries had deterioration. A significant association between death and the loss of motor function, situated toward the oral or nasal region, relative to the initial level of cervical spinal cord injury within the first 30 days of the injury (ascension) was observed. The onset of ascension could be categorized into early, delayed and late deterioration. Early deterioration (less than 24 hours) was typically related to traction and immobilization. Delayed deterioration (between 24 hours and seven days) was associated with sustaining hypotension in patients with fracture dislocations. Late deterioration (more than seven days) was observed in one patient with vertebral artery injuries.

Harrop J, Sharan A, Vaccaro A, et al. The cause of neurologic deterioration after acute cervical spinal cord injury. Spine 2001:26(4), pp. 340-345.

Chiropractic Research Review

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