Indication for Surgery

The indications for surgery in the patient with a spinal cord injury may be either
neurosurgical or orthopaedic or a combination of the two. Before considering whether
surgery would be appropriate, measures must be taken to assure that no further neurologic
injury occurs, and a careful neurologic and radiologic evaluation must be performed to
determine the extent and nature of the spinal cord and spinal injury.

The absolute indications for surgical management of a traumatic spinal cord injury are

evidence of a progressive neurological deficit or a dislocation-type injury to the spinal
column (displaced and unstable)

 Cervical spine surgery aims to realign the spine, decompress the neural tissue, and
stabilise the spine with internal fixation (screws, plates, cages)

 Thoracolumbar spine surgery typically involves spinal decompression, discectomy,

spinal fixation, or spinal cord simulation

Studies have shown earlier surgical intervention (within 24 hours) is associated with better
outcomes.

 Franklin C. Wagner, Bahram Chehrazi (1980). Spinal Cord Injury: Indications for
Operative Intervention, Surgical Clinics of North America, Volume 60, Issue 5, pages
1049-1054, ISSN 0039-6109, https://doi.org/10.1016/S0039-6109(16)42232-2

Spinal immobilisation

 Initial care - immobilisation:

 Immobilize the entire spine of any patient with known or potential SCI
 Immobilize neck with a hard collar.
 Use log roll with adequate personnel to turn patient while maintaining spine
alignment
 For children < 8 years of age use an airway pad to promote neutral cervical spine
position 
 Remove from spinal board on arrival in ED or as soon as resuscitation allows 
  Maintain neck in neutral position by use of a hard collar, but change to two-piece
collar for comfort and avoidance of complications (e.g. pressure area, venous
obstruction, aspiration) within 6 hours of admission. 
 Early surgery:
 Surgery may be required in the situation of a reversible compression injury, or
deteriorating neurology with a spinal injury amenable to some form of reduction
and or fixation. 
 Halo & Orthotic devices:
 Some patients may have Halo devices applied by surgeons, or a brace made by
orthotics to maintain correct alignment of the spine. These devices are fixed to the
child’s chest.
 Ensure you know how to open devices to perform chest compressions in the event
of a cardiac arrest, and that spinal immobilisation is maintained manually
throughout any resuscitation 
 Move patient using slide sheets or pat slide with adequate number of personnel to
maintain spinal alignment 
 No pharmacological agent has been proven to limit damage and optimize recovery of
function. If steroids have already been given, cease them when resuscitation completed.
Aim for normal perfusion pressure and oxygenation of SC. 
 Once the extent and stability of the injury has been determined a documented plan should
be formulated to ensure immobilisation and stabilisation. 

REFERENCE
https://www.rch.org.au/rchcpg/hospital_clinical_guideline_index/
Spinal_Cord_Injury_Acute_Management/