A Patient with Acute Cervical Cord Injury and COVID-19: A First Case Report

American Journal of Physical Medicine & Rehabilitation, 2020 · DOI: 10.1097/PHM.0000000000001485 · Published: January 1, 2020

Spinal Cord Injury COVID-19 Rehabilitation

Simple Explanation

This case report discusses a patient who had both a severe spinal cord injury and COVID-19 concurrently, which resulted in serious consequences for the patient and healthcare staff. The patient, a 28-year-old male, suffered a C5-6 burst fracture with complete C5 tetraplegia following a motorcycle accident and was later found to have a SAR-CoV-2 infection. The unrecognized COVID-19 infection led to the quarantine of a significant number of surgical and rehabilitation staff. Despite receiving standard treatment, the patient unexpectedly died. Rehabilitation personnel should consider the combined effects of SCI and COVID-19, as well as the risk of virus transmission, to ensure safe and effective rehabilitation programs.

Study Duration

Not specified

Participants

A 28-year-old male with acute cervical SCI and COVID-19

Evidence Level

Case Report

Key Findings

1
The patient's COVID-19 infection was initially undetected due to the absence of typical symptoms and exposure history at the time of admission screening.
2
The patient developed mild COVID-19 pneumonia, but the ultimate cause of death was determined to be cervical spine injury leading to cervical cord injury, with COVID-19 pneumonia as a comorbid condition.
3
The case highlights the challenges in screening and managing patients with SCI during the COVID-19 pandemic, including the risk of large-scale quarantines of healthcare staff.

Research Summary

This case report describes a patient with acute cervical SCI and concurrent COVID-19, highlighting the difficulties in diagnosis, management, and prevention of transmission. The patient's unrecognized COVID-19 infection led to quarantine of hospital staff and ultimately the patient's death, despite treatment. The report emphasizes the importance of considering the combined effects of SCI and COVID-19, implementing thorough screening protocols, and taking precautions to prevent viral transmission in rehabilitation settings.

Practical Implications

Enhanced Screening Protocols

Implement more intensive screening for SAR-CoV2 infection in all SCI patients undergoing surgical and rehabilitation therapy, regardless of initial symptoms or exposure history.

VTE Prophylaxis

Be vigilant about the risk of VTE in acute SCI patients, especially with concurrent COVID-19, and consider adjusting prophylactic dosages accordingly.

Rehabilitation Adaptations

Consider alternative rehabilitation services such as home-based rehabilitation and telerehabilitation to minimize the risk of viral transmission in hospital settings.

Study Limitations

1
The exact cause of death could not be proven due to the absence of an autopsy.
2
The report is based on a single case, limiting the generalizability of the findings.
3
The study did not explore the long-term effects of COVID-19 on SCI patients.

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