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  • Print publication year: 2003
  • Online publication date: August 2009

29 - Spinal Cord Injury



Spinal cord injuries at or above the C4 level can result in respiratory compromise. When the level of injury is just below the origins of the phrenic nerves, intercostal muscle function is lost, and the patient can be completely dependent on diaphragmatic contraction for respiration. Various degrees of transient neurological disability may occur as a result of a phenomenon known as spinal shock. Spinal shock results from physiological transection of the spinal cord, which commonly lasts 24-48 hours. Acute cervical strain is the most common injury following a vehicular accident. Injuries to the carotid and vertebral arteries and jugular veins are commonly associated with spinal cord injuries caused by gun shot wounds. The Third National Acute Spinal Cord Injury Randomized Controlled Trial (NASCIS III) concluded that high-dose methylprednisolone administration is associated with improved neurological outcome in spinal cord-injured patients. Spinal cord injuries are rare in patients under 17 years old.
Hurlbert, R J. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg. 2000; 93: 1–7
Nesathurai, S. Steroids and spinal cord injury: revisiting the NASCIS 2 and NASCIS 3 trials. J Trauma. 1998; 45: 1088–93