5 Spinal Cord Injury

Initial assessment

Suspected spinal cord injury calls for rapid trauma assessment while protecting spinal alignment. For a patient with neck pain and tingling in both hands after a fall, use the trauma primary survey, assess airway, breathing, and circulation, and perform a focused neurologic assessment. Do not move the neck through its range of motion to test for pain, and do not delay assessment while waiting for imaging.

Neurologic assessment and reassessment

Record motor strength and sensation in each extremity and repeat the assessments to detect changes. A comprehensive neurologic examination and classification can follow when the patient is stable. Pain alone, skin temperature at the injury site, or ability to sit does not replace assessment of motor and sensory function.

Spinal motion restriction and transfers

Altered mental status, midline spinal tenderness, and new neurologic symptoms such as leg weakness support spinal motion restriction. During transfers, trained staff should minimize unwanted movement and maintain alignment of the head, neck, and torso through a coordinated transfer. Do not ask the patient to turn independently, and do not remove precautions merely because the patient can move both arms.

A long board may assist with transfer, but it is not intended for prolonged routine care.

Recognizing neurogenic shock

A high spinal cord injury can disrupt sympathetic control, resulting in vasodilation and hypotension, often accompanied by bradycardia. Hypotension and a slow heart rate with warm skin may be consistent with neurogenic shock, but they do not establish the cause of shock on their own.

Assess urgently for trauma-related bleeding and other causes of shock. Do not assume that low blood pressure is neurogenic without evaluation. Neurogenic shock is not the same condition as spinal shock.

Emergency management priorities

When suspected acute spinal cord injury is accompanied by worsening breathing or low blood pressure, address immediate threats to life first. Support oxygenation and ventilation, treat circulatory instability, maintain spinal alignment, and urgently escalate for trauma-team care. Classifying the injury should not take priority over these immediate needs.

Hospital teams may use fluids, vasopressors, and individualized blood-pressure support. Management should follow current specialist guidance.

Putting the priorities together

Care centers on rapid trauma assessment, documentation and reassessment of motor and sensory function, and spinal motion restriction when indicated. Neurogenic shock can present with hypotension and bradycardia after high spinal cord injury, but bleeding and other causes must also be considered. Stabilize airway, breathing, and circulation, maintain alignment, and escalate promptly for definitive trauma care.