An important goal is to prevent secondary injury to the spine or spinal cord, hence all road accident patients are handled and mobilized as potential spine injury patients until cleared by adequate imaging like x-rays, CT/MRI at the hospital.

Initial immobilization of the cervical spine with a hard collar and long spine boards for the thoracolumbar spine is valuable during transporting a spine injury patient to a trauma center.

Those with cervical cord injury could have respiratory difficulties and should be carried supine, with attention to maintaining a patent airway and avoiding chest constriction and blood pressure should be maintained on a slightly higher side(mean arterial pressure (MAP) ≥ 85 mm Hg) to improve spinal cord perfusion and to reduce hypotensive episodes that may adversely affect neurological recovery.

Clinical Assessment on clinical inspection and palpation, tenderness, gap, bruising, edema muscle spasm can be present over the spine.

Essential part of spine injury evaluation The use of the American Spinal Injury Association (ASIA) Impairment Scale has become a standard guideline in the neurological assessment of patients with spine injuries. It helps in identifying the level of injury, classify the type of spinal cord injury(complete or incomplete) and help in prognosticating the possible neurological recovery.

Traditionally, plain x-rays are taken of any possibly injured areas. However, CT is being used increasingly as the primary imaging study for spinal trauma because it has better diagnostic accuracy and can be obtained rapidly. CT Angiography can be required for evaluation of vertebral artery injury or before planning cervical spine surgery. MRI helps identify the type and location of cord injury; it is the most accurate study for imaging the spinal cord and other soft tissues.

Role of Steroid

There is continued controversy around the role of high dosage Methylprednisolone (MPSS) in reducing the impact of spinal cord injury. Each hospital, region, or country can have its protocol. We follow to offer a 24-hour infusion of high-dose MPSS to adult patients who present within 8 hours with acute spinal cord injury.

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Surgical management vs Non-surgical management

Whether to perform surgery or treat without operation depends upon the nature of the spine injury and the status of neurology of the patient. We make this rational decision using Thoracolumbar Injury Classification and Severity Score (TLICSS) and sub axial cervical spine injury classification (SLIC) based on clinical examination and MRI scan findings. This scoring systems aid treatment decision-making of surgery vs non-surgical method of treatment for patients.

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The principles of Surgical treatment are as follows:

• To preserve neurological function
• To decompress the damaged neurological structures
• To stabilizes the spine
• To facilitate rehabilitation

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Post-Operative Care

• After 1-2 hours of monitoring in the recovery room, patients are shifted toward. Oral fluid intake started after 4 hours and gradually switched to a full diet. Most of the patients with normal neurology before surgery can stand and walk by the next morning and can be sent home accordingly in 1-2 days. However, patients with neurological deficits will require intensive physical rehabilitation which may require to continue for many months. Rehabilitation strategies focus on the prevention of secondary complications, promoting neuro recovery, addressing underlying impairments, and maximizing function with aim of making the patient as independent as possible.

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Wound Care and follow up

Before leaving the hospital, a waterproof dressing is applied to the surgical wound, and the patient can take shower and will be called on the 5th post-op day for a dressing checkup and change of medication if needed.

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Complications

Surgery for Spinal trauma is generally considered a very safe procedure, however, like any other surgery, there are several risks and complications associated with are:

• Operative wound infection
• Dural tear and CSF leakage
• Bleeding
• Implant related complication- loose screw, broken implant
• Adjacent segment disease
• Pseudoarthrosis or non-union
• Nerve root damage
• Bowel/bladder incontinence
• Deep vein thrombosis, which occurs when blood clots form in the leg

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