approach to spinal trauma

Approach to spinal trauma patient

Assessment (concomitant injury, neurological deficit,
Concomitant injury
1．Head, chest, long bone injury
2．Chance fx: associated with hollow viscus injury

Neurological deficit
1． ASIA score (American spinal injury association)
2． Clinical assessment

Sacral sparing & spinal shock
Bulbocarvenous reflex: mark of resolution of spinal shock
Penile or urethra stimulation → contracture of anal sphincter


ASIA score
A: complete injury
B: Sensory preserved
C: Motor preserved, MP < 3
D: Motor preserved, MP > 3
E: Normal

Clinical assessment
1． Central Cord syndrome
2． Brown sequard
3． Anterior Cord
4． Conus Medullaris
5． Cauda equina

C-spine imaging
．3 views: AP, LAT, Odontoid
．5 views: 3 views + oblique
．dynamic view: flex-ext view, time consuming in acute stage, muscle spasm masked subtle instability
．unconscious patient: LAT view only

T-L imaging
．plain film, CT, MRI for soft tissue injury
．included abdominal CT scan to exclude intra-abdominal injury

Classification of T-L spine injury
．AO classification, Denis system

Denis system
．3 column theory
．Comperssion, Burst, Seat-belt type, Fx-dislocation