What is included in the initial clinical evaluation of spinal cord injury (SCI)?

Updated: Nov 01, 2018
  • Author: Lawrence S Chin, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Answer

As with all trauma patients, initial clinical evaluation of a patient with suspected spinal cord injury (SCI) begins with a primary survey. The primary survey focuses on life-threatening conditions. Assessment of airway, breathing, and circulation (ABCs) takes precedence. A spinal cord injury must be considered concurrently. [31, 32, 4]

Perform careful history taking, focusing on symptoms related to the vertebral column (most commonly pain) and any motor or sensory deficits. Ascertaining the mechanism of injury is also important in identifying the potential for spinal injury.

The axial skeleton should be examined to identify and provide initial treatment of potentially unstable spinal fractures from both a mechanical and a neurologic basis. The posterior cervical spine and paraspinal tissues should be evaluated for pain, swelling, bruising, or possible malalignment. Logrolling the patient to systematically examine each spinous process of the entire axial skeleton from the occiput to the sacrum can help identify and localize injury. The skeletal level of injury is the level of the greatest vertebral damage on radiograph.

Complete bilateral loss of sensation or motor function below a certain level indicates a complete spinal cord injury.


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