Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXXIII: Wounds and Injuries of the Spinal Column and Cord

Introduction

United States Department of Defense

Combat injuries of the spinal column, with or without associated spinal cord injury, differ from those generally encountered in civilian practice. Whereas the majority of civilian spinal column and cord trauma is closed, most combat injuries are open, contaminated, and usually associated with other organ injuries.

Management of the casualty with spinal column or cord injury is initially the same as for all casualties. Regardless of whether the wounds are single or multiple, open or closed, and involve one or multiple organ systems, medical intervention must be prioritized. The first priorities remain: A-airway, B-breathing, and C-circulation, followed by evaluation and management of less compelling problems. After the ABCs have been addressed, management of the spinal cord injury takes on a high priority.

From the prognostic standpoint, the greater the initial function retained, the better the neurological outcome. Data from both military and civilian spinal cord injury sources reveal that in those injuries presenting with immediate loss of motor and sensory function (complete injury), the likelihood of neurological recovery is minimal and will not be influenced by surgical intervention. On the other hand, operation may be neurologically beneficial in the incomplete injury in which there is evidence of neurological deterioration-and a potentially reversible cause of the deterioration. Even though the neurological outcome of the open, complete injury is not likely to be influenced by surgical intervention, operation is generally indicated to debride the wound so as to minimize the risk of CNS sepsis.

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Operational Medicine 2001

Health Care in Military Settings

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