Management of cervical spine injury

Field assessment, neck immobilization, oxygenation and maintenance of the airway occur in suspected cervical-spine-injured patients before transport to a regional spinal cord injury centre. After cervical spine radiography, bony alignment of the spinal column is re-established and mean blood pressure is maintained at 80–90mmHg with fluids and, if necessary, inotropic support. Predetermined guidelines are used for intubation and ventilation and for invasive monitoring of patients in spinal shock. Fluid challenge is used to assess reserve cardiac function and the need for fluid infusion, restriction or inotropic support. Evoked potential monitoring provides a non-invasive, objective and sensitive method to assess neuroconduction through a spinal cord injury and may be used to replace a wake-up test intraoperatively. There are no randomized prospective studies showing that surgical decompression and/or internal stabilization improves outcome compared with non-surgical treatment of acute cervical spine injury. Respiratory failure is managed by long-term ventilator support, diaphragm pacing or use of glossopharyngeal breathing. Chest physiotherapy is helpful in reducing the occurrence of atelectasis and pneumonia. Hyperreflexic syndromes during surgery are avoided with adequate anaesthesia during stimulation. An area with a population near one million should designate a regional spinal cord injury centre. Such centres decrease the proportion of patients with complete neurological injury.