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The acute phase management of traumatic spinal cord injury (tSCI) with polytrauma: A narrative review

Brain and Spine, 2024 · DOI: https://doi.org/10.1016/j.bas.2024.104146 · Published: November 28, 2024

Spinal Cord InjurySurgeryTrauma

Simple Explanation

Traumatic spinal cord injury (tSCI) is frequently observed in polytrauma patients, requiring a multidisciplinary approach for optimal management. Damage control resuscitation and surgery are crucial to stabilize the patient and minimize bleeding until definitive hemostasis is achieved. Protecting the injured spine during emergency surgery is essential to prevent further damage. Early imaging, especially MRI, is important for surgical decision-making, and early decompressive surgery (within 24 hours) is linked to better neurological outcomes. Early consultation with rehabilitation specialists is beneficial for optimizing recovery. Collaboration among different medical specialties is advisable to improve patient outcomes in tSCI polytrauma cases.

Study Duration
Not specified
Participants
Not specified
Evidence Level
Narrative Review

Key Findings

  • 1
    Damage control resuscitation (DCR) and damage control surgery (DCS) are essential for preventing and correcting post-traumatic physiological derangements to minimize bleeding until hemostasis is achieved.
  • 2
    Spinal protection during emergency surgery is critical to reduce secondary insults to the injured spine.
  • 3
    Early decompressive surgery (within 24 h from trauma) is associated with better neurological outcomes.

Research Summary

This narrative review consolidates knowledge on the acute phase management of tSCI patients within the context of polytrauma, underscoring the necessity of a multidisciplinary approach. It highlights the importance of rapid bleeding control integrated with a 'time is spine' approach to improve both mortality and neurological disability. The review calls for more well-powered studies to enhance the evidence base in this complex clinical setting.

Practical Implications

Optimized Resuscitation Strategies

Implementing damage control resuscitation and surgery protocols can improve outcomes by quickly stabilizing polytrauma patients with tSCI.

Improved Surgical Timing

Prioritizing early decompressive surgery within 24 hours of trauma can lead to better neurological outcomes for tSCI patients.

Enhanced Multidisciplinary Collaboration

Fostering close collaboration among specialties such as critical care, surgery, and rehabilitation can optimize the management of complex tSCI polytrauma cases.

Study Limitations

  • 1
    Limited data available regarding optimal patient management during emergency surgery for tSCI polytrauma patients.
  • 2
    Lack of specific guidelines regarding coagulation management in tSCI patients.
  • 3
    Studies regarding the utilization of TXA in tSCI are lacking and should be implemented.

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