Pathophysiology, presentation and management of spinal cord injury

Spinal cord impairment (SCI) may arise from traumatic and non-traumatic causes. Traumatic causes include blunt trauma and penetrating injury. Examples of non-traumatic causes include cord compression from disc prolapse or bone metastasis from a primary cancer. SCI leads to complete loss or altered motor function and sensation, and disruption of autonomic function. SCI can be described by level of vertebral column injury and by level and severity of neurological deficit using the International Standards for Neurological Classification of Spinal Cord Injury developed by the American Spinal Injury Association as a universal classification tool for SCI. This classification tool involves sensory and motor examination to determine neurological level of injury and whether the injury is complete or incomplete. Acute SCI patients have a complex and evolving pathophysiology and it is important to appreciate the altered physiology particularly in the acute stages of management. Intensive care monitoring and surgical intervention are likely to be required to manage the altered physiology and vertebral column injuries respectively. A multidisciplinary approach with specialist SCI centre input ensures optimal management from time of diagnosis and has been shown to have a significant effect on long-term functional outcome for patients. Since August 2013 a national pathway has been in place to facilitate rapid referral from a major trauma centre to an SCI Centre. The pathway sets out key goals and objectives to be achieved within defined time frames as the patient moves from the acute phase of injury into the rehabilitation and reintegration phase.