Prehospital treatment Spine motion restriction with a long spine board The first stage in the management of a suspected<unk>  is geared toward basic life support and preventing further<unk> : maintaining airway, breathing, and circulation and restricting further motion of the spine. In the emergency setting, most people who has been subjected to forces strong enough to cause<unk>  are treated as though they have instability in the<unk>  column and have<unk>  motion restricted to prevent damage to the<unk> <unk> .<unk> es or fractures in the head, neck, or pelvis as well as penetrating trauma near the spine and falls from heights are assumed to be associated with an unstable<unk>  column until it is ruled out in the hospital. High-speed vehicle crashes, sports<unk> es involving the head or neck, and diving<unk> es are other mechanisms that indicate a high<unk>  risk. Since head and<unk>  trauma frequently coexist, anyone who is unconscious or has a lowered level of consciousness as a result of a head<unk>  is<unk>  motion restricted. A rigid cervical collar is applied to the neck, and the head is held with blocks on either side and the person is strapped to a backboard. Extrication devices are used to move people without excessively moving the spine if they are still inside a vehicle or other confined space. The use of a cervical collar has been shown to increase mortality in people with penetrating trauma and is thus not routinely recommended in this group. Modern trauma care includes a step called clearing the cervical spine, ruling out<unk>  if the patient is fully conscious and not under the influence of drugs or alcohol, displays no neurological deficits, has no pain in the middle of the neck and no other painful<unk> es that could distract from neck pain. If these are all absent, no<unk>  motion restriction is necessary. If an unstable<unk>  column<unk>  is moved, damage may occur to the<unk> <unk> . Between 3 and 25% of<unk> s occur not at the time of the initial trauma but later during treatment or transport. While some of this is due to the nature of the<unk>  itself, particularly in the case of multiple or massive trauma, some of it reflects the failure to adequately restrict motion of the spine.<unk>  can impair the body's ability to keep warm, so warming blankets may be needed. Early hospital treatment Initial care in the hospital, as in the prehospital setting, aims to ensure adequate airway, breathing, cardiovascular function, and<unk>  motion restriction. Imaging of the spine to determine the presence of a<unk>  may need to wait if emergency surgery is needed to stabilize other life-threatening<unk> es. Acute<unk>  merits treatment in an intensive care unit, especially<unk> es to the cervical<unk> <unk> . People with<unk>  need repeated neurological assessments and treatment by neurosurgeons. People should be removed from the spine board as rapidly as possible to prevent complications from its use. If the systolic blood pressure falls below 90 mmHg within days of the<unk> , blood supply to the<unk> <unk>  may be reduced, resulting in further damage. Thus it is important to maintain the blood pressure which may be done using intravenous fluids and vasopressors. Vasopressors used include phenylephrine, dopamine, or norepinephrine. Mean arterial blood pressure is measured and kept at 85 to 90 mmHg for seven days after<unk> . The CAMPER Trial led by Dr Kwon and subsequent studies by the UCSF TRACK-SCI group (Dhall) have shown that<unk> <unk>  perfusion pressure (SCPP) goals are more closely associated with better neurologic recovery than MAP goals. Some institutions have adopted these SCPP goals and lumbar CSF drain placement as a standard of care. The treatment for shock from blood loss is different from that for neurogenic shock, and could harm people with the latter type, so it is necessary to determine why someone is in shock. However it is also possible for both causes to exist at the same time. Another important aspect of care is prevention of insufficient oxygen in the bloodstream, which could deprive the<unk> <unk>  of oxygen. People with cervical or high thoracic<unk> es may experience a dangerously slowed heart rate; treatment to speed it may include atropine. The corticosteroid medication methylprednisolone has been studied for use in<unk>  with the hope of limiting swelling and secondary<unk> . As there does not appear to be long term benefits and the medication is associated with risks such as gastrointestinal bleeding and infection its use is not recommended as of 2018. Its use in traumatic brain<unk>  is also not recommended. Surgery may be necessary, e.g. to relieve excess pressure on the<unk> , to stabilize the spine, or to put vertebrae back in their proper place. In cases involving instability or compression, failing to operate can lead to worsening of the condition. Surgery is also necessary when something is pressing on the<unk> , such as bone fragments, blood, material from ligaments or intervertebral discs, or a lodged object from a penetrating<unk> . Although the ideal timing of surgery is still debated, studies have found that earlier surgical intervention (within 12 hours of<unk>  is associated with better outcomes. This type of surgery is often referred to as "Ultra-Early", coined by Burke et al. at UCSF. Sometimes a patient has too many other<unk> es to be a surgical candidate this early. Surgery is controversial because it has potential complications (such as infection), so in cases where it is not clearly needed (e.g. the<unk>  is being compressed), doctors must decide whether to perform surgery based on aspects of the patient's condition and their own beliefs about its risks and benefits. Recent large-scale studies have shown that patients who do undergo earlier surgery (within 12–24 hours) experience significantly lower rates of life-threatening complications and spend less time in hospital and critical care. However, in cases where a more conservative approach is chosen, bed rest, cervical collars, motion restriction devices, and optionally traction are used. Surgeons may opt to put traction on the spine to remove pressure from the<unk> <unk>  by putting dislocated vertebrae back into alignment, but herniation of intervertebral disks may prevent this technique from relieving pressure. Gardner-Wells tongs are one tool used to exert<unk>  traction to reduce a fracture or dislocation and to reduce motion to the affected areas. Rehabilitation<unk>  patients often require extended treatment in specialized<unk>  unit or an intensive care unit. The rehabilitation process typically begins in the acute care setting. Usually, the inpatient phase lasts 8–12 weeks and then the outpatient rehabilitation phase lasts 3–12 months after that, followed by yearly medical and functional evaluation. Physical therapists, occupational therapists, recreational therapists, nurses, social workers, psychologists, and other health care professionals work as a team under the coordination of a physiatrist to decide on goals with the patient and develop a plan of discharge that is appropriate for the person's condition. drop foot orthosis has only one functional element for lifting the forefoot in order to compensate for a weakness in the dorsiflexors. If other muscle groups, such as the plantar flexors, are weak, additional functional elements must be taken into account. An ankle-foot orthoses (AFO) of the drop foot orthosis type is therefore not suitable for the care of patients with weakness in other muscle groups. In the acute phase physical therapists focus on the patient's respiratory status, prevention of indirect complications (such as pressure ulcers), maintaining range of motion, and keeping available musculature active. For people whose<unk> es are high enough to interfere with breathing, there is great emphasis on airway clearance during this stage of recovery. Weakness of respiratory muscles impairs the ability to cough effectively, allowing secretions to accumulate within the lungs. As<unk>  patients suffer from reduced total lung capacity and tidal volume, physical therapists teach them accessory breathing techniques (e.g. apical breathing, glossopharyngeal breathing) that typically are not taught to healthy individuals. Physical therapy treatment for airway clearance may include manual percussions and vibrations, postural drainage, respiratory muscle training, and assisted cough techniques. Patients are taught to increase their intra-abdominal pressure by leaning forward to induce cough and clear mild secretions. The quad cough technique is done lying on the back with the therapist applying pressure on the abdomen in the rhythm of the cough to maximize expiratory flow and mobilize secretions. Manual abdominal compression is another technique used to increase expiratory flow which later improves coughing. Other techniques used to manage respiratory dysfunction include respiratory muscle pacing, use of a constricting abdominal binder, ventilator-assisted speech, and mechanical ventilation. The amount of functional recovery and independence achieved in terms of activities of daily living, recreational activities, and employment is affected by the level and severity of<unk> . The Functional Independence Measure (FIM) is an assessment tool that aims to evaluate the function of patients throughout the rehabilitation process following a<unk>  or other serious illness or<unk> . It can track a patient's progress and degree of independence
Spinal cord injury
Spinal tumor
Vascular myelopathy
Posterior cord syndrome
Basal ganglia disease
Spinal disease
Syringomyelia
Central cord syndrome