Neurology

Spinal Cord Injury

Spinal cord injury disrupts motor, sensory and autonomic pathways below a lesion; early priorities are spinal protection, oxygenation, perfusion and specialist trauma care, with neurogenic shock and autonomic dysreflexia as key emergencies.

Definition

Spinal cord injury is damage to the spinal cord that impairs motor, sensory or autonomic conduction, most commonly from trauma but also from compression, ischaemia or inflammation. It is classified by neurological level and completeness using the ASIA/ISNCSCI framework.

First principles

Primary injury is followed by preventable secondary injury

Mechanical damage at the time of trauma is followed by oedema, haemorrhage, ischaemia and inflammation that can extend the lesion. Early care therefore prioritises airway, breathing, spinal protection, oxygenation and avoidance of hypotension rather than an unproven neuroprotective drug. NICE advises against methylprednisolone, nimodipine and naloxone for neuroprotection in acute traumatic spinal cord injury.

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