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Spine and spinal cord injuries (SCIs) can be devastating, life-changing events that include injury to the bony elements (vertebral fracture), the neural elements (spinal cord and nerve root injury), or both.


The spinal cord is most commonly injured by a direct mechanical cause, with resultant hemorrhage, edema, and ischemia. Patients may complain of neck and back pain, and close examination may note pain or bony abnormalities with palpation. Unstable spinal fractures may present without obvious spinal cord or nerve root trauma. Symptomatic patients may complain of paresthesias, dysesthesias, weakness, bowel or bladder incontinence, urinary retention, or other sensory disturbances with or without specific physical examination findings. More severely injured patients may have obvious neurologic deficits.

Complete spinal cord lesions are characterized by the absence of sensory and motor function below the level of injury (Figs. 161-1 and 161-2).

Figure 161-1

Spinal cord level. The spinal cord level of injury can be delineated by physical examination, including a detailed neurologic examination.

Figure 161-2

Dermatomes for sensory examination.

Incomplete lesions have a better prognosis, and denote some degree of neurologic activity below the injury, but their initial diagnosis may be obscured because of spinal shock. Spinal shock is the temporary loss or depression of spinal reflex activity below the level of injury to the spinal cord. Spinal shock can persist for days to weeks and prohibit the differentiation of an incomplete and complete lesion (Table 161-1).

Table 161-1

Four Major Incomplete Spinal Cord Syndromes

Neurogenic shock refers to the loss of sympathetic innervation leading to relative bradycardia and hypotension. Hemorrhage must be excluded as the explanation for hypotension before neurogenic shock is considered. The presence of neurogenic shock may necessitate inotropic support.

Spinal cord injury without radiographic abnormality (SCIWORA) is an entity seen most often in the pediatric population. Numbness, paresthesias, ...

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