In this episode, we review spinal trauma, focusing on rapid recognition, evaluation, and early management of potential spinal instability and neurologic injury. We discuss common mechanisms such as motor vehicle collisions, falls, and diving injuries, and emphasize the importance of spinal motion restriction when trauma patients present with risk factors like midline tenderness, neurologic deficits, altered mental status, or distracting injuries. The episode also covers key clinical decision tools including the NEXUS criteria and Canadian C-spine rule, along with appropriate imaging strategies—highlighting CT as the preferred modality for fractures and MRI for ligamentous or spinal cord injuries. We review vertebral fracture classifications, the TLICS scoring system, and critical complications such as spinal cord injury and neurogenic shock. Finally, we outline essential management principles, including maintaining adequate spinal cord perfusion and preventing hypotension, to help reduce secondary neurologic injury.

References

1. Bushardt RL, Colomb-Lippa DM, Klinger AM, Reed H. The JAAPA QRS Review for PAs: Study Plan and Guide for PANCE and PANRE. 1st ed. LWW; 2021. ISBN: 9781975143817.
2. Alizadeh A, Dyck SM, Karimi-Abdolrezaee S. Traumatic Spinal Cord Injury: An Overview of Pathophysiology, Models and Acute Injury Mechanisms Front. Neurol.. 2019; 10.
3. Mensah EO, Chalif JI, Johnston BR, et al. Traumatic spinal cord injury: a review of the current state of art and future directions – what do we know and where are we going? North American Spine Society Journal (NASSJ). 2025; 22:100601-.
4. van Den Hauwe L, Sundgren PC, Flanders AE. Spinal Trauma and Spinal Cord Injury (SCI) 2020 Feb 15. In: Hodler J, Kubik-Huch RA, von Schulthess GK, editors. Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging [Internet]. Cham (CH): Springer; 2020. Chapter 19. Available from: https://www.ncbi.nlm.nih.gov/books/NBK554330/ doi: 10.1007/978-3-030-38490-6_19