Case of the Month #38 Spinal Cord Injury

Published 27/04/2023

What are your ongoing concerns with this patient?

The primary concerns for the patient are: 

  • An unstable C-spine fracture with neurological involvement  

  • Haemodynamic instability  

This patient has an unstable cervical spine injury; spinal immobilisation and timely fixation, if appropriate, is paramount. Definitive management strategies will be based on a combination of clinical and radiological features and may be conservative or surgical. 

Spinal immobilisation with spinal collars is recommended by both NICE and the Joint Royal Colleges Ambulance Liaison Committee; there is however increasing debate as to the role of spinal collars in the management of SCI and these recommendations may change in the future. 

Hypotension in this case is likely to be due to neurogenic shock relating to a high spinal fracture. Other potential causes such as haemorrhage from other traumatic injuries should be excluded. Hypotension for even a brief period has been associated with worse neurological outcomes and should be avoided. There is no clear consensus regarding the optimal blood pressure however to help prevent secondary spinal cord injury a mean arterial pressure (MAP) of >85-90 mmHg has shown weak evidence (class III) of a better outcome.