Top Spinal Cord Inj Rehabil 2006;12(1):22–37 © 2006 Thomas Land Publishers, Inc. www.thomasland.com 22 arly management of a patient with spinal cord injury (SCI) begins at the scene of the injury. The average age E of patients sustaining an SCI is 19 years, and motor vehicle accidents are the leading cause of injury. 1–6 It is estimated that up to 25% of SCIs occur after the initial traumatic insult, either during transit or early in the course of management. 5–10 As many as 20% of spinal column injuries involve multiple, noncon- Emergency Transport and Radiographic Evaluation Following Spinal Cord Injury Kornelis A. Poelstra, Alexander R. Vaccaro, Sonali Rao, Deepan Patel, Andrew K. Brown, Peter G. Whang, and Alpesh Patel Kornelis A. Poelstra, MD, PhD, is Spine Fellow, Thomas Jefferson University, The Rothman Insti- tute, Philadelphia, Pennsylvania, and University of Maryland, Orthopaedic Surgery – Shock Trauma Center. Alexander R. Vaccaro, MD, is Spine Surgeon, Thomas Jefferson University, The Rothman Institute, Philadel- phia, Pennsylvania. Sonali Rao, BS, is medical student, Thomas Jefferson University, Philadelphia, Pennsylvania. Deepan Patel, BS, is medical student, Thomas Jefferson University, Philadelphia, Pennsylvania. The prehospital care of patients with spinal cord injury has improved significantly since the founding of the Emergency Medical Services (EMS) in 1971. Rapid and safe transport of the spinal injury patient allows for early medical stabilization and institution of measures designed to preserve and possibly improve neurologic function. The adoption of systematic imaging protocols and advancements in imaging technology have allowed for early diagnosis of spinal injuries and therefore definitive treatment. Controversy still exists as to the basic imaging requirements needed to exclude the presence of spinal injury or the need for prereduction magnetic resonance imaging in a patient with a cervical facet dislocation. Key words: cervical spine, emergency transport, imaging, radiographic evaluation, spinal cord injury, trauma Andrew K. Brown, MD, is Orthopaedic Resident, Thomas Jefferson University, The Rothman Institute, Philadelphia, Pennsylvania. Peter G. Whang, MD, is Spine Fellow, Thomas Jefferson University, The Rothman Institute, Philadel- phia, Pennsylvania. Alpesh Patel, MD, is Spine Fellow, Thomas Jefferson University, The Rothman Institute, Philadelphia, Pennsylvania. tinuous vertebral levels; therefore, the entire spinal column is potentially at risk. 11–14 As a consequence, complete spine immobiliza- tion and cross-body strapping is recom- mended in the transport of patients to the hospital setting. 13–20 During the last 30 years, the neurological status of SCI patients arriving in emergency departments has dramatically improved. During the 1970s, most patients (55%) re- Downloaded from http://meridian.allenpress.com/tscir/article-pdf/12/1/22/1982853/2008-tknv-pqqx-puh4.pdf by guest on 25 September 2023