Critical care for concomitant severe traumatic brain injury and acute spinal cord injury in the polytrauma patient: illustrative case

J Neurosurg Case Lessons, 2022 · DOI: 10.3171/CASE21521 · Published: January 10, 2022

Simple Explanation

The paper discusses the challenges of treating patients who have both traumatic brain injuries (TBI) and spinal cord injuries (SCI) after a traumatic event. The initial focus is on stabilizing the patient's breathing and blood flow, immobilizing the spine, and quickly getting them to a trauma center. Early surgery is important to relieve pressure on the brain and spinal cord and to stabilize the spine. The authors present a case of a 19-year-old who had both severe brain and spinal cord injuries after a fall. The patient underwent several surgeries and a lengthy rehabilitation, but ultimately showed significant improvement.

Study Duration

Not specified

Participants

1 patient: 19-year-old male

Evidence Level

Level 4: Case Report

Key Findings

1
Early operative interventions should be performed for intracranial pathology followed by intraspinal pathology, as dictated in our institutional practice.
2
Secondary insults occur across a more protracted phase and require imperative attention and correction.
3
Patients can make considerable recovery, particularly younger patients, who are more likely to beneﬁt from early aggressive interventions and medical treatment.

Research Summary

The occurrence of traumatic brain injury with spinal cord injury (SCI) in polytrauma patients is associated with signiﬁcant morbidity. The approach to initial management of concomitant head and spine trauma is to establish intracranial stability followed by intraspinal stability. Patients can make considerable recovery, particularly younger patients, who are more likely to beneﬁt from early aggressive interventions and medical treatment.

Practical Implications

Treatment Paradigm

The treatment paradigm of combined TBI and SCI is highly variable and an evolving specialized ﬁeld, requiring specific expertise and resources.

Prioritization of Interventions

In the acute period after initial trauma, treatment of intracranial dysfunction takes precedence over spinal cord pathology.

Multidisciplinary Support

A patient with concurrent TBI and SCI requires extended hospitalization and rehabilitation, but there is potential for considerable progress toward regaining functional independence through multidisciplinary support.

Study Limitations

1
Management is complex and understudied.
2
Current TBI models of prognostication are not speciﬁc to this subpopulation of patients.
3
Knowledge of predictors of recovery in this patient population remains lacking.

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