The acute phase management of traumatic spinal cord injury (tSCI) with polytrauma: A narrative review

Abstract

Introduction: Traumatic spinal cord injury (tSCI) is frequently observed in polytrauma patients. Research question: What is the optimal strategy to manage tSCI in the setting of polytrauma? Material and methods: This narrative review focuses on: 1) extraspinal damage control surgery and resuscitation, 2) the perioperative protection of the injured spine during emergency surgery, 3) imaging and timing of spinal surgery in polytrauma, 4) early interventions for skin, bowel and bladder, and 5) the multidisciplinary approach to tSCI polytrauma patients. Results: Damage control resuscitation (DCR) and damage control surgery (DCS), aim to prevent/correct post-traumatic physiological derangements to minimize bleeding until definitive hemostasis is achieved. Spinal protection during emergency surgery is of paramount importance to reduce secondary insults to the injured spine. Imaging, especially magnetic resonance imaging (MRI), is useful for decision-making regarding surgical management of the injured spine. Early decompressive surgery (within 24 h from trauma) is associated with better neurological outcomes. Early consultation with a physical medicine and rehabilitation physician is beneficial to optimize recovery. A close collaboration between different medical specialties involved in the early management of tSCI patients with polytrauma is advisable to improve outcome. Discussion and conclusion: This narrative review aims to collate basic knowledge regarding acute phase management of tSCI patients in the context of polytrauma. More evidence and data form well-powered studies are necessary in this setting.

Keywords

• Traumatic spinal cord injury
• Polytrauma
• Multidisciplinary approach
• Emergency surgery
• Spinal trauma
• Damage control surgery