Chapter 6 - Spine emergencies

Summary

This chapter presents the key facts, emergency evaluation and management, symptoms, physical examination findings, and treatment of spine emergencies, namely acute spine injuries, cauda equina syndrome, spinal epidural abscess (SEA), vertebral compression fractures and lumbar disc herniation. If an injury is identified, the spine must be protected until definitive management is provided. If a patient has an occipitocervical dissociation, immediate application of a halo is recommended given the highly unstable nature of the injury. Patients should undergo emergent MRI if there is suspicion of cauda equina syndrome. Prompt diagnosis and treatment is essential to prevent neurologic deterioration and maximize recovery. Most compression fractures are successfully managed with rest, activity modification, analgesics and bracing. Two-thirds of patients respond to non-operative care. The ability to perform a thorough and accurate neurologic evaluation is essential in determining normal from abnormal and assessing whether the findings are attributable to a disc herniation.