If cervical spinal cord injury (SCI) is suspected, hemodynamic stability is an initial priority [1]. An assessment of respiratory and cardiovascular functions should be done afterward. Firstly, a historical data about concomitant chronic pulmonary and circulatory diseases should be collected as they may interfere with vital laboratory data results [2].

Cervical segments of the spinal cord are responsible for delivering autonomic commands and regulation of cardiovascular and respiratory system, impairment in these systems should always be suspected. For pulmonary function assessment, it is important to consider the frequency of respiration, the involvement of abdominal and accessory respiratory muscles in breathing, the mobility of chest wall and possible injuries to it e.g. pneumothorax, hemothorax. In auscultation investigate lungs for abnormal sounds and impaired functioning. To measure blood oxygenation, perform ABG analysis and pulse oximetry [2].

When judging circulatory functions, the possibility of damage to the autonomic system should cause alertness for likely hemorrhagic or neurogenic shock. As nervous system conduit is impaired, the typical signs of shock e.g. vasoconstriction may be absent [2].

On examination of the neck, physicians should look for signs that could indicate an injury to the spinal cord, like hematomas, inflammation (redness, swelling), pain, tenderness and potential interruption of vertebral alignment. It is recognized, that clinical examination, although reliable, is prone to error and further radiologic investigations are essential [3] [4].

To determine the location of injured segments, a standardized evaluation method like International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) is available. It is widely used and recognized [1], and provides information about motor, sensory and neurologic outcomes of the SCI [5]. Sensory characteristics are graded using pinching maneuver or abrasion on various dermatomes innervated by certain root nerves [1]. Motor functions are graded performing flexion, extension, as well as specific movements of muscle groups (myotomes) innervated by the certain nerves. Evaluation of type of SCI, whether it is complete or incomplete is also possible with ASIA Impairment Scale (AIS) [1].

Patients with cervical SCI can develop a constellation of syndromes associated with the injury, some of them are described here. Central cord syndrome is the most common and is combined with weakness in upper and lower limbs [5] [6]. Brown-Sequard syndrome is derived from a spinal cord lesion dividing it in half and is characterized as ipsilateral loss of sensation [6].

• High Fever

  Neither high fever nor pharyngeal pain has recurred at latest follow-up, 5 years after surgery. [ncbi.nlm.nih.gov]

• Muscle Spasticity

  spasticity (increased muscle tone) management Medicines and alternative methods of managing pain and spasticity Psychological counseling Identifying problems and solutions for thinking, behavioral, and emotional issues Family support Assistance with [hopkinsmedicine.org]

  Muscle tone. Some people with spinal cord injuries experience one of two types of muscle tone problems: uncontrolled tightening or motion in the muscles (spasticity) or soft and limp muscles lacking muscle tone (flaccidity). Fitness and wellness. [mayoclinic.org]

  Spasticity can reduce venous pooling and stabilize the thoracic and abdominal muscles used in respiration. [americannursetoday.com]

  Spinal cord injury prevents the brain from telling the muscle to relax. The result is prolonged muscle contraction or spasticity. [encyclopedia.com]

• Edema of the Upper Extremity

  The secondary outcomes were edema (cm) and the upper-extremity motor scores of the International Standards for the Neurological Classification of Spinal Cord Injury (ISNCSCI). [ncbi.nlm.nih.gov]

• Cervical Enlargement

  Impaired circulation in the artery of cervical enlargement is significant in extension of perifocal ischemia. [ncbi.nlm.nih.gov]

• Hyperreflexia

  While the cause of oculosympathetic spasm remains speculative, it may represent a localized form of autonomic hyperreflexia. [ncbi.nlm.nih.gov]

  Autonomic hyperreflexia The chronic phase in which spinal reflexes reappear is characterized by autonomic hyperreflexia in a high proportion of patients. [trauma.org]

  Sympathetic hyperreflexia can develop suddenly and without warning. [ceaccp.oxfordjournals.org]

  One emergency department study found that nine patients who presented with severe myelopathy had a low incidence of extensor plantar responses and hyperreflexia. 1 View/Print Table TABLE 3 Levels of Spinal Nerve Root Supply and Measures for Evaluating [aafp.org]

  absent bulbocavernosus reflex reflex characterized by anal sphincter contraction in response to squeezing the glans penis or tugging on an indwelling Foley catheter timing variable but usually resolves within 48 hours at its conclusion spasticity, hyperreflexia [orthobullets.com]

• Spastic Paralysis

  Muscle relaxants: If spastic paralysis develops, muscle relaxants, such as baclofen or tizanidine, may be used. [merckmanuals.com]

Spinal cord injury can be primary (from trauma) as well as secondary (from consequent edematous or hemorrhagic compression), for that reason radiographic imaging and magnetic resonance imaging (MRI) are necessary. Diagnostics are necessary for distinguishing the location of the lesion, its size, and signs of compression for further treatment.

• Plain radiography has almost been dismissed from favorable technique list for its low sensitivity, and more sophisticated radiologic examinations, preferably, MRI are recommended [7]. If physicians choose an X-ray, anterospinal, lateral and odontoid views should be performed [8].
• Computed tomography (CT) is usually the first test to be executed when on suspicion of SCI, particularly if patient is lethargic, unconscious, has neurological disturbances, pain, and sensitivity in the cervical area [3]. CT detects most lesions of bone tissue but does not detect those of ligaments and spinal cord [8]. CT scans are more convenient than plain radiography and can demonstrate sites of the injury that are obscure to X-ray. Images of occiput to T1 segment should be obtained in coronal and sagittal planes [8].
• Magnetic resonance imaging is the most accurate and reliable test that is usually carried out after pathology in CT cervical scan is confirmed [9]. In MRI a radiologist usually looks for signs and level of compression in the spinal cord that could be due to hemorrhages and perifocal edemas. Parameters of the spinal cord lesions, surrounding soft tissue injuries, and herniations in disks are also established if present [10].

The SCIM improvement rate at discharge was 60% in the surgical treatment group and 20% in the non-surgical treatment group. [ncbi.nlm.nih.gov]

In regard to the signal changes in the spinal cord, the patients who showed no signal change on T1- and T2-weighted images had a better prognosis. [ncbi.nlm.nih.gov]

The etiology may have been mechanical due to patient positioning, or toxic, from contrast medium injection in the vessels feeding the spinal cord, or a combination of both. [ncbi.nlm.nih.gov]

[…] atlanto-occipital dissociation occipital condyle fracture cervical spine fractures discoligamentous injury anterior subluxation (posterior ligamentous complex rupture) facet joint dislocation spinal epidural hematoma spinal cord injury vertebral artery dissection Etiology [radiopaedia.org]

Reid DC, Henderson R, Saboe L, Miller JDR: Etiology and clinical course of missed cervical spine fractures. J Trauma 1987; 27:980-6. Davis JW, Phreaner DL, Hoyt DB, Mackersie RC: The etiology of missed cervical spine injuries. [anesthesiology.pubs.asahq.org]

Clinical and epidemiologic data were recorded from the medical records along with several radiologic findings from the initial computed tomographic scan and MRI. Data were analyzed using a non-parametric test. [ncbi.nlm.nih.gov]

Patient Population: Prevalence and Epidemiology Knee // Shoulder & Elbow // Hip // Spine // Foot & Ankle // Hand & Wrist Fragility Fractures: Diagnosis and Treatment Shoulder & Elbow The Characteristics of Surgeons Performing Total Shoulder Arthroplasty [amjorthopedics.com]

Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine 2001;26S:2. Tator CH, Duncan EG, Edmonds VE, et al. Changes in epidemiology of acute spinal cord injury from 1947 to 1981. Surg Neurol 1993;40:207. [uscspine.com]

The rapid improvement in function following the operation in these patients was gratifying and emphasizes the pathophysiological importance of spinal compression in this condition. [ncbi.nlm.nih.gov]

Pathophysiology and pharmacologic treatment of acute spinal cord injury. Spine J 2004;4:451. Rizzolo SJ, Vacarro AR, Cotler JM: Cervical spine trauma. Spine 1994;19:2288. Sekhon LH, Fehlings MG. [uscspine.com]

Pathophysiology The goals of resuscitation should be stabilization of the cervical spine, prevention of secondary injury, reduction of the fracture as soon as possible and protection of the spinal cord. [trauma.org]

To this end, anesthesiologists must have a thorough understanding of pathophysiology and optimize their skills and equipment to make an anesthesia plan. [nrronline.org]

The emphasis of our presentation concerns the frequency of some of the main complications and their attempted prevention: the haemodynamic disturbances caused by over-hydration; the prevention of haemorrhagic stress ulcers is not only by the use of specific [ncbi.nlm.nih.gov]

View Article PubMed Google Scholar Pak CY: Medical prevention of renal stone disease. Nephron. 1999, 81: 60-65. 10.1159/000046300. View Article PubMed Google Scholar Pearle MS: Prevention of nephrolithiasis. [bmcfampract.biomedcentral.com]

There are four areas that an athlete can focus on to prevent a serious neck injury. [sportsmd.com]

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3. Como JJ, Diaz JJ, Dunham CM, et al. Practice Management Guidelines for Identification of Cervical Spine Injuries Following Trauma: Update From the Eastern Association for the Surgery of Trauma Practice Management Guidelines Committee. J Trauma. September 2009; 67(3):651-659.
4. Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a Set of Clinical Criteria to Rule Out Injury to the Cervical Spine in Patients with Blunt Trauma. N Engl J Med 2000; 343:94-99.6. Nowak DD, Lee JK, Gelb DE, Poelstra KA, Ludwig SC. Central cord syndrome. J Am Acad Orthop Surg. 2009 Dec;17(12):756-65.
5. Kirshblum SC, Burns SP, Biering-Sorensen F, et al. International standards for neurological classification of spinal cord injury (Revised 2011). J Spinal Cord Med. 2011 Nov; 34(6): 535–546.
6. Nowak DD, Lee JK, Gelb DE, Poelstra KA, Ludwig SC. Central cord syndrome. J Am Acad Orthop Surg. 2009 Dec;17(12):756-65.
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