Epidemiology:

• The incidence of spinal cord injury (SCI) is estimated to be 54 cases per 1 million people in the United States, with over 17,000 new cases annually and a prevalence of around 291,000.
• The lifetime cost of caring for a single patient with cervical SCI is estimated to be over 9.7 billion in the United States.

Etiology:

• Vehicular crashes remain the leading cause of SCI, followed by falls, violence, and sports-related causes.
• Considering other nontraumatic etiologies such as ankylosing spondylitis, spina bifida, polio, osteoporosis, multiple sclerosis, spinal stenosis, and others is essential for thorough assessment.

Pathophysiology:

• SCI results from traumatic or nontraumatic causes leading to the disruption of motor, sensory, or autonomic function.
• SCI comprises a primary phase of physical compression of the spinal cord and a secondary phase of cell membrane permeability changes, resulting in neurologic deficits.

Initial Management:

• Maintaining a high index of suspicion, spinal immobilization, and thorough history and physical examination are crucial in the initial management of suspected SCI.
• Resuscitation of hypotensive patients with SCI should proceed as with all trauma patients and may require isotonic fluid replacement or blood transfusion.
• Imaging, such as computed tomography (CT) and magnetic resonance imaging (MRI), is essential for diagnosing and assessing the extent of spinal cord injury.

Conditions for Range-of-Motion Assessment:

• Patients with low-risk factors such as simple rear-end motor vehicle collision and delayed onset of neck pain may allow for range-of-motion assessment without the need for imaging.
• Active rotation of the neck 45 degrees to the left and right can also eliminate the need for imaging if the patient is able to rotate their neck, regardless of pain.

Management Approaches for Obtunded Patients:

• For obtunded patients, the options for management include leaving the cervical collar in place until a clinical examination can be performed, removing the collar based on a negative CT alone, or obtaining an MRI of the cervical spine, with no specific guideline recommendation for one method over another.

Patient Disposition:

• The disposition of the patient, especially in the case of cervical injuries, for respiratory monitoring is recommended, and intensive care unit admission is advised.