RECOMMENDATIONS:

1- Administration of methylprednisolone (MP) for the treatment of acute spinal

cord injury
(SCI) is not recommended. (LEVEL IA ).>> Congress of Neurological Surgeons

2- Do not use the following medications, aimed at providing neuroprotection

and prevention of secondary deterioration, in the acute stage after acute
traumatic spinal cord injury:
methylprednisolone
nimodipine level 1b
naloxone. level 1b
(NICE).

3- Offer medications to control pain in the acute phase after spinal injury.
For people with spinal injury use intravenous morphine as the first-line
analgesic and adjust the dose as needed to achieve adequate pain relief.
CONSIDER ketamine as a second line drug. (NICE).

4- Diagnostic imaging: (NICE)

## Perform MRI for children (under 16s) if there is a strong
suspicion of:

cervical spinal cord injury as indicated by the Canadian Cspine

rule and by clinical assessment or

cervical spinal column injury as indicated by clinical assessment or

abnormal neurological signs or symptoms, or both.

##Perform CT in adults (16 or over) if:

 imaging for cervical spine injury is indicated by the Canadian Cspine rule or
there is a strong suspicion of thoracic or lumbosacral spine injury associated
with abnormal neurological signs or symptoms.
If, after CT, there is a neurological abnormality which could be attributable to
spinal cord injury, perform MRI.

Suspected thoracic or lumbosacral column injury only (children and adults)

1.5.9Perform an X-ray as the first-line investigation for people with
suspected spinal column injury without abnormal neurological signs or
symptoms in the thoracic or lumbosacral regions (T1L3).
1.5.10Perform CT if the X-ray is abnormal or there are clinical signs or
symptoms of a spinal column injury.
1.5.11If a new spinal column fracture is confirmed, image the rest of the
spinal column.

Use whole-body CT (consisting of a vertex-to-toes scanogram followed by CT from

vertex to mid-thigh) in adults (16 or over) with blunt major trauma and suspected
multiple injuries. Patients should not be repositioned during whole-body CT.

Clinical Neurologic Assessment for Spinal Cord Injury

Perform a baseline neurological assessment on any patient with suspected spinal injury
or spinal cord injury (SCI) to document the presence of SCI. If neurologic deficits are
consistent with SCI, determine a neurological level and the completeness of injury.
Perform serial examinations as indicated to detect neurological deterioration or
improvement.
Prevention and Treatment of Venous Thromboembolism Congress of Neurological
Surgeons

Level I
Prophylactic treatment of venous thromboembolism (VTE) in patients with
severe
motor deficits due to spinal cord injury is
recommended.
The use of low molecular weight heparins,
rotating beds, or a combination of modalities
is recommended as a prophylactic treatment
strategy.
Low dose heparin in combination with pneumatic compression stockings or
electrical stimulation is recommended as a prophylactic treatment strategy
Level II
Low dose heparin therapy alone is not
recommended as a prophylactic treatment
strategy.
Oral anticoagulation alone is not recommended as a prophylactic treatment
strategy.
Early administration of VTE prophylaxis
(within 72 hours) is recommended.
A 3-month duration of prophylactic treatment for deep vein thrombosis (DVT)
and
pulmonary embolism (PE) is recommended.

Diagnosis:
Level III
Duplex Doppler ultrasound, impedance plethysmography, venous occlusion
plethysmography, venography, and the clinical examination are recommended for
use as diagnostic tests for
DVT in the spinal cord injured population.
Genitourinary Tract
Place an indwelling urinary catheter as part of the initial patient assessment unless
contraindicated. If contraindicated, use emergent suprapubic drainage instead.
Gastrointestinal Tract
Initiate stress ulcer prophylaxis.
(Scientific evidenceI/III/IV; Grade of recommendationA)
Consortium for Spinal Cord Medicine

Initial Closed Reduction of Cervical Spinal

Fracture-Dislocation Injuries (CNS)
Level III
Early closed reduction of cervical spinal fracture/dislocation
injuries with craniocervical traction for the restoration of anatomic
alignment of the cervical spine in awake patients is recommended.