Critical Care in the Acute Cervical Spinal Cord Injury

Cervical spinal cord injuries are common and have a devastating impact on the lives of both victims and families. The cost of caring for these patients both in the acute period and chronically over the course of their lives can often overwhelm family and societal resources. Appropriate early management of acute cervical spinal cord injuries can clearly improve long-term functionality and therefore quality of life for these patients. Improved outcomes also decrease cost in the long term. Intensivists are often challenged with halting the progression of neurologic damage and managing the multisystemic sequelae that develop subsequent to the initial injury. This mandates a thorough understanding of the mechanism of illness and the pathophysiology of multisystemic disease. We review the literature in an attempt to illustrate current, evidence-based management strategies in acute spinal cord-injured patients from the standpoint of a critical care physician. We focus on the period immediately following the initial injury through the intensive care unit stay.