Review the prevalence and types of spinal cord injuries.
Evaluate airway management choices in patients with spinal cord injuries.
Review the implications of spinal cord injuries on intraoperative anesthetic management.
Discuss the anesthetic implications of neuromonitoring in patients with spinal cord injuries.
Spinal cord injury (SCI) is a common traumatic injury that often requires hospitalization and surgical intervention. As a result, the anesthesiologist encounters many patients with SCI at various stages of their hospitalization, both in and out of the operating room. There are several aspects of their care, including airway management, initial resuscitation, and intraoperative management, that require a particular understanding of their disease and for which the anesthesiologist is particularly suited.
PREVALENCE AND ETIOLOGY OF SPINAL CORD INJURY
Spinal column injury encompasses a wide range of pathologies, from the minor to the life-threatening. The bony structure of the spine encloses, protects, and supports the spinal cord. Injury may occur anywhere from the articulation of the cervical spine with occiput to the sacrum. It may include fractures of the bone or ligamentous injury, and it may or may not have underlying cord damage, the presence of which would define SCI. Insult to the cord comprises a spectrum of disease depending on the location of the injury and the nature of the deficit (see Chapter 13).
A population-based study evaluating spinal column injury in a Canadian community demonstrated less than a 6 percent incidence of neurologic injury in persons who sustain a spinal column fracture .