Spine Surgery and Spinal Trauma
Core rules
- Assess spinal cord injury with the ASIA impairment scale: motor and sensory levels, sacral sparing and completeness guide prognosis.
- Neurogenic shock causes hypotension with bradycardia after cervical or high thoracic cord injury; spinal shock is transient loss of reflexes and flaccidity, not a blood-pressure diagnosis.
- Cauda equina syndrome is a surgical emergency: saddle anaesthesia, bladder or bowel dysfunction, bilateral leg pain and progressive deficit require urgent MRI.
- Spinal clearance in trauma follows validated clinical criteria and imaging; ankylosing spondylitis and diffuse idiopathic skeletal hyperostosis increase fracture instability.
- Maintain cord perfusion, avoid hypotension, immobilize appropriately and avoid traction that worsens alignment.
Worked example
A 45-year-old falls from height with C6 sensory level, bradycardia and hypotension. Reasoning: treat neurogenic shock with careful fluid and vasopressors after excluding haemorrhage, immobilize the spine, obtain CT and MRI, and discuss early surgery for compression or instability. Steroid use is not routine.
Traps
Do not attribute hypotension solely to cord injury before excluding bleeding. Do not miss sacral sparing. Do not clear the cervical spine in an intoxicated patient using plain films alone.
Key points are listed separately.