“Standards for management of acute spinal cord injury have been developed based on evidence since the 2017 AO Spine/Cervical Spine Research Society, which is evidence-based,” Greg Vigna, MD, JD, Board Certified PM&R
Injury Care Solutions Group offers expert services as to the standard of care for the diagnosis of spinal cord injury (SCI) and cauda equina syndrome (CES).
1. Expert Services include:
2. Emergency Medicine Physicians
3. Emergency Room Nurses
4. Emergency Medicine: Physician Assistants/Nurse Practitioners
5. Neurosurgeons
6. Orthopedic Spine
7. Neuroradiologist
8. Physical Medicine Rehabilitation Specialist: Spinal Cord Injury Medicine
9. Life Care Planning
Management of Acute Spinal Cord Injury, “Time is Spine”, by Dr. Michael Fehlings, MD, Ph.D.:
“To assist clinicians in the management of patients with acute SCI, our multidisciplinary, international team recently sought to address three key topics related to acute SCI: 1) the role and timing of surgical decompression;2) optimal hemodynamic management; and 3) risk stratification, diagnosis, and treatment of intraoperative SCI.
1. There was a strong consensus around the recommendation that surgery for acute SCI be undertaken within 24 hours when “medically feasible.”
2. Unfortunately, the clinical evidence was not sufficient to allow for recommendations on spinal cord perfusion management.
3. We recommended that multimodal intraoperative neuromonitoring be used to identify a potential intraoperative SCI and that a care pathway be adopted to optimize the management of these patients.”
Management of Acute Cauda Equina Syndrome, by Dr. Orla Hennessy:
“There is evidence that clinical evaluation alone is neither sensitive nor specific enough to make or rule out a diagnosis of CES, regardless of who performs the evaluation.
”To avoid missing the diagnosis, all cases of suspected CES should have an urgent MRI scan. As this is a time-critical condition, this should be performed as soon as possible.
The most widely adopted red flags in current guidelines are those of saddle sensory disturbances, urinary and bowel dysfunction.
It is important to note that new or worsening bilateral radiculopathy with or without neurological findings should be a key indicator for seeking urgent MRI.
There is clear evidence for benefit in early surgical intervention within 24–48 hours.”
¹Fehlings, et al. Editorial. The AO Spine/Praxis Spinal Cord Institute clinical practice guidelines for acute spinal cord injury: interpretation and implications for clinical practice. Journal of Neurosurgery. Vol. 42: Issue 4, pages 526-529
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