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Chapter-36 Initial Evaluation of Patients with Spinal Injuries

BOOK TITLE: Spinal Infections and Trauma

Author
1. Dalvie Samir
2. Patil SS
ISBN
9789350250754
DOI
10.5005/jp/books/11196_36
Edition
1/e
Publishing Year
2011
Pages
8
Author Affiliations
1. PD Hinduja National Hospital and, Medical Research Center, Mumbai, Maharashtra, India, Bombay Hospital and Medical Research Centre, Mumbai 400020, Hinduja and Breach Candy Hospitals, Mumbai, Maharashtra, India, (UK); (UK); (UK);PD Hinduja Hospital, Breach Candy Hospital, Mumbai, maharashtra, India
2. PD Hinduja National Hospital and Medical Research Centre, Mumbai, Maharashtra, India
Chapter keywords

Abstract

Spinal injuries are extremely serious injuries that affect the younger population. The overall incidences of spinal injuries varies from 25 to 59 cases per million, with an average age of 40 years. Historically, the outlook for these patients has been bleak. However, with advances in imaging and diagnostic modalities, surgical techniques, rehabilitation and improved concepts of neuroprotection and neuroregeneration, the patient with spinal injury has an improved chance of leading a socially productive life. Delay or missing a diagnosis of a spinal trauma could lead to increased morbidity. Principal causes of missing such injuries include a low level of suspicion, failure of the patient to report for medical care, failure to ask for appropriate imaging and missing injuries on imaging studies. Other causes include polytrauma, intoxicated state and other central nervous system injuries. Equally, the spinal injury may distract the physician from diagnosing other systemic or skeletal injuries. Fifty to sixty percent of patients with spinal cord injury have associated injuries ranging from closed fractures to serious life-threatening injuries. The aim of an adequate initial evaluation of spinal cord injury is early recognition of specific injury, prompt resuscitation of the patient, stabilization of the spinal injury, and avoidance of additional injuries and medical complications. This can be achieved by a thorough history and standardized physical examination as per the American Spinal Injury Association guidelines followed by appropriate investigations. Evaluation and resuscitative measures necessarily need to be performed simultaneously in this setting. Priorities are to be given to life and limb saving measures, while simultaneously diagnosing the spinal injury and ensuring neural protection.

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