Management of spinal trauma in emergency department

Spinal cord injuries are traumatic incidents which lead to serious clinical consequences and affect the lives of individuals and their families. Despite all medical and surgical advances, optimal treatment still remains a serious clinical problem. It is mostly not possible to prevent the primary injury arising from trauma exposure in spite of all measures taken. However, some biochemical events developing in spinal cord following the primary injury cause more damage to the cord. This process also defined as the secondary injury increases the importance of emergency department approach to patients with acute spinal trauma. Emergency department practices in spinal cord injuries are extremely important in terms of both primary care and prevention of complications. 

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  • Baron, B.J., McSherry, K.J., Larson, J.L., Scalea, T.M., 2011. Spine and spinal cord trauma. In Tintinalli’s Emergency Medicine. A Comprehensive Study Guide. Chapter 255. Judith, E., Tintinalli, J.S., Stapczynski, D.M., Cline, O.J., Ma, R.K., Cydulka, G.D., Meckler, eds. McGraw-Hill. New York, pp. 1569-1582.
  • Bayless, P., Ray, V.G., 1989. Incidence of cervical spine injuries in association with blunt head trauma. Am. J. Emerg. Med. 7, 139-142.
  • Berker, M., 2004. Spinal kord yaralanmaları. Yoğun Bakım Dergisi 4, 220-226.
  • Bracken, M.B., Collins, W.F., Freeman, D.F., Shepard, M.J., Wagner, F.W., Silten, R.M., Hellenbrand, K.G., Ransohoff, J., Hunt, W.E., Perot, P.L., 1984. Efficacy of methylprednisolone in acute spinal cord injury. JAMA. 251, 45-52.
  • Bracken, M.B., Shepard, M.J., Collins, W.F., Holford, T.R., Baskin, D.S., Eisenberg, H.M., Flamm, E., Leo-Summers, L., Maroon, J.C., Marshall, L.F., 1992. Methylprednisolone or naloxone treatment after acute spinal cord injury: 1-year follow-up data. Results of the second national acute spinal cord injury study. J. Neurosurg. 76, 23-31.
  • Bracken, M.B., Shepard, M.J., Collins, W.F., Holford, T.R., Young, W., Baskin, D.S., Eisenberg, H.M., Flamm, E., Leo-Summers, L., Maroon, J., 1990. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the second national acute spinal cord ınjury study. N. Engl. J. Med. 322, 1405-1411.
  • Bracken, M.B., Shepard, M.J., Holford, T.R., Leo-Summers, L., Aldrich, E.F., Fazl, M., Fehlings, M.G., Herr, D.L., Hitchon, P.W., Marshall, L.F., Nockels, R.P., Pascale, V., Perot, P.L., Piepmeier, J., Sonntag, V.K., Wagner, F., Wilberger, J.E., Winn, H.R., Young, W., 1998. Methylprednisolone or tirilazad mesylate administration after acute spinal cord injury: 1-year follow up. Results of the third national acute spinal cord injury randomized controlled trial. J. Neurosurg. 89, 699-706.
  • Bradley, W.G., 2008. Sinir sistemi travması, spinal kord travması. In neurology in clinical practice. Tan, E., Özdamar, S.E,. eds. Veri Medikal Yayıncılık, İstanbul, pp. 1115-1144.
  • Dryden, D.M., Saunders, L.D., Rowe, B.H., May, L.A., Yiannakoulias, N., Svenson, L.W., Schopflocher, D.P., Voaklander, D.C, 2003. The epidemiology of traumatic spinal cord injury in Alberta, Canada. Can. J. Neurol. Sci. 30, 113-121.
  • Dumont, R.J., Verma, S., Okonkwo, D.O., Hurlbert, R.J., Boulos, P.T., Ellegala, D.B., Dumont, A.S., 2001. Acute spinal cord injury, part II: Contemporary pharmacotherapy. Clin. Neuropharmacol. 24, 265-279.
  • Fehlings, M.G., Sekhon, L.H., Tator, C., 2001. The role and timing of decompression in acute spinal cord injury: What do we know? What should we do? Spine. 26, 101-110.
  • George, E.R., Scholten, D.J., Buechler, C.M., Jordan-Tibbs, J., Mattice, C., Albrecht, R.M., 1995. Failure of methylprednisolone to improve the outcome of spinal cord injuries. Am Surg. 61, 659-663.
  • Hall, A.J., Wagle, V.G., Raycroft, J., Goldman, R.L., Butler, A.R., 1993. Magnetic resonance imaging in cervical spine trauma. J. Trauma. 4, 21Hoffman, J.R., Mower, W.R., Wolfson, A.B., Todd, K.H., Zucker, M.I., 2000. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. National Emergency X-Radiography Utilization Study Group. Engl. J. Med. 343, 94-99.
  • Hurlbert, R.J., 2000. Methylprednisolone for acute spinal cord injury: An inappropriate standard of care. J. Neurosurg. 93, 1-7.
  • Is, M., Safak, A.A., 2005. Servikal omurga yaralanmalarında tanı görüntüleme yöntemleri. Düzce Tıp Fakültesi Dergisi. 1, 35-42.
  • Kaptanoğlu, E., Torun, F., Atar A., 2005. Spinal travma. In Temel Nöroşirurji, Volume 2. Aksoy, K., Paloğlu, S., Pamir, N., Tuncer, R., Eds. Türk Nöroşirurji Derneği Yayınları, Ankara, pp. 1144-1231.
  • Kiriş, T., Görgülü, A., 2005. Omurilik travmaları. In Travma, Ertekin, C. , Taviloğlu, K., Güloğlu, R., Kurtoğlu, M., Eds. İstanbul Medikal Yayıncılık, İstanbul, pp. 805-818.
  • Kiwerski, J.E., 1993. Application of dexamethasone in the treatment of acute spinal cord injury. Injury. 24, 457-460.
  • Kortbeek, J.B., Al Turki, S.A., Ali, J., Antoine, J.A., Bouillon, B., Brasel, K., Brenneman, F., Brink, P.R., 2008. Advanced trauma life support, 8th edition, the evidence for change. J. Trauma. 64, 1638-1650.
  • Maynard, F.M., Bracken, M.B., Creasey, G., Ditunno, J.F., Donovan, W.H., Ducker, T.B., Garber, S.L., Marino, R.J., Stover, S.L., Tator, C.H., Waters, R.L., Wilberger, J.E., Young, W., 1997. International Standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Spinal Cord. 35, 266-274.
  • Otani, T., Kai, S., Narushima, M., 1994. Ejaculation obtained by intracavernous papaverine in a cervical spinal cord injury patient resulting in pregnancy and childbirth. Case report. Paraplegia. 32, 180-181.
  • Pointillart, V., Petitjean, M.E., Wiart, L., Vital, J.M., Lassié, P., Thicoipé, M., Dabadie, P., 2000. Pharmacological therapy of spinal cord injury during the acute phase. Spinal Cord. 38, 71-76.
  • Poynton, A.R., O’Farrell, D.A., Shannon, F., Murray, P., McManus, F., Walsh, M.G., 1997. An evaluation of the factors affecting neurological recovery following spinal cord injury. Injury. 28, 545-548.
  • Prendergast, M.R., Saxe, J.M., Ledgerwood, A.M., Lucas, C.E., Lucas, W.F., 1994. Massive steroids do not reduce the zone of injury after penetrating spinal cord injury. J. Trauma. 37, 576-579.
  • Raineteau, O., Schwab, M.E., 2001. Plasticity of motor systems after incomplete spinal cord injury. Nat. Rev. Neurosci. 2, 263-273.
  • Schouten, R., Albert, T., Kwon, B.K., 2012. The spine-injured patient: Initial assessment and emergency treatment. J. Am. Acad. Orthop. Surg. 20, 336-346.
  • Stahel, P.F., VanderHeiden, T., Finn, M.A., 2012. Management strategies for acute spinal cord injury: Current options and future perspectives. Curr. Opin. Crit. Care. 18, 651-660.
  • Tator, C.H., 2002. Strategies for recovery and regeneration after brain and spinal cord injury. Inj. Prev. 8, 33-36.
  • Tator, C.H., Fehlings, M.G., 1991. Review of the secondary injury theory of acute spinal cord trauma with emphasis on vascular mechanisms. J. Neurosurg. 75, 15-26.
  • Topsakal, C., Erol, F.S., Ozveren, M.F., Yilmaz, N., Ilhan, N., 2002. Effects of methylprednisolone and dextromethorphan on lipid peroxidation in an experimental model of spinal cord injury. Neurosurg. Rev. 25, 258-266.
  • Waters, R.L, Meyer, P.R., Adkins, R.H., Felton, D., 1999. Emergency, acute, and surgical management of spine trauma. Arch. Phys. Med. Rehabil. 80, 1383-1390.
  • Zileli, M., 1997. Omurilik yaralanmasının farmakolojik tedavisi. In Omurilik ve Omurga Cerrahisi, Zileli, M., Özer, F., Eds. Saray Medikal Yayıncılık, İzmir, pp. 466- 478.