SPINAL-CORD INJURY

Spinal cord injury (SCI) is a global health problem that afflicts young adults and the elderly. Motor vehicle accidents and falls remain the leading cause of SCI. It is becoming a significant social burden due to improved survival rate and access to care. In order to understand the effect of SCI, a good understanding of the functional and topographic anatomy of the spinal cord is important. The primary insult of SCI is a direct consequence of the trauma resulting in mechanical damage to the cord. Secondary injury occurs as a result of cord edema and hypoperfusion. The severity of SCI is classified by using the American Spinal Injury Association Impairment Scale. The initial phase of SCI management involves the basic ABCDE, and management of other life-threatening injuries. Once stabilized, expeditious, focused radiographic imaging is important for diagnosis of SCI. Early surgical intervention has been shown to improve clinical outcomes. Patients with high thoracic or cervical SCI may demonstrate hemodynamic instability due to sympathectomy, which requires invasive monitoring in the operating room and intensive care unit. There are significant changes to the cardiovascular, pulmonary, gastrointestinal, and urinary physiology of SCI patients, which require specialized care in a neurocritical care unit followed by intense rehabilitation therapies.