Traumatic spinal cord injury

Spinal cord compression is mechanical narrowing of the spinal canal by tumor, hematoma, abscess, disc herniation, or trauma that produces myelopathy; it is a neurologic emergency requiring urgent MRI of the affected level and immediate treatment of the cause, since surgical decompression rarely restores function once paraplegia develops.

Neurogenic bladder is dysfunction of bladder storage or emptying caused by disease or injury of the central or peripheral nervous system, producing either a spastic, high-pressure bladder with urgency incontinence or an atonic, high-volume bladder with retention and overflow incontinence depending on lesion location. Diagnosis rests on the neurologic history and exam with urodynamic testing, and management is centered on a regular, low-pressure emptying regimen, most often clean intermittent catheterization, to protect renal function and prevent infection.

Myelopathy is spinal cord dysfunction from extrinsic compression or intrinsic cord pathology, most often degenerative cervical spondylosis, producing combined upper and lower motor neuron findings. MRI of the suspected level confirms the diagnosis; management ranges from a 6 to 8 week conservative trial to emergent surgical decompression, antibiotics, or high dose glucocorticoids depending on cause.

Syringomyelia is a fluid-filled cavity (syrinx) within the spinal cord, most often arising from Chiari I malformation, trauma, or a spinal cord tumor. It produces a classic cape-like loss of pain and temperature sensation as the syrinx damages the crossing spinothalamic fibers, diagnosed by MRI and treated surgically when progressive.

Transverse myelitis is inflammation across one or more contiguous spinal cord segments causing subacute weakness, a sensory level, and bladder or bowel dysfunction; diagnosis requires spinal MRI showing cord enhancement or CSF inflammation with exclusion of compressive and infectious causes, and idiopathic disease is treated with high-dose intravenous methylprednisolone.

Cauda equina syndrome is compression of the lumbosacral nerve roots below the spinal cord causing saddle anesthesia, bladder or bowel dysfunction, bilateral leg weakness with areflexia, and low tone, most often from a large central lumbar disk herniation. It is a surgical emergency diagnosed by emergent MRI of the lumbar spine and treated with urgent decompression.

Spinal epidural abscess is a suppurative infection of the spinal epidural space, most often hematogenous Staphylococcus aureus, presenting with fever, focal spinal pain, and, if missed, progressive weakness. The diagnosis is established by emergent MRI with contrast. Treatment is empiric intravenous vancomycin plus ceftriaxone or cefepime, with emergent surgical decompression whenever a neurologic deficit is present.

Aortic dissection is a tear in the aortic intima allowing blood to split the media, creating a false lumen, and is a surgical emergency. Type A (ascending) dissection needs emergency surgery, while type B (descending) is usually managed medically with rapid heart-rate and blood-pressure control; the priority is impulse control with a beta-blocker first.

Traumatic brain injury is structural or functional brain damage from biomechanical force, graded moderate (Glasgow Coma Scale 9-12) or severe (Glasgow Coma Scale 3-8) when imaging shows contusion, edema, or hemorrhage; management centers on preventing hypotension and hypoxia, controlling intracranial pressure with hyperosmolar therapy and, when refractory, decompressive craniectomy.

Pressure ulcers (pressure injuries) are localized areas of skin and soft-tissue damage over a bony prominence, most often the sacrum, ischium, heel, or trochanter, caused by unrelieved pressure, friction, moisture, and shear in an immobilized patient. Management begins with immediate pressure redistribution and repositioning at least every 2 to 3 hours, paired with wound-bed debridement, moisture-balanced dressings, and culture-directed antibiotics reserved for spreading cellulitis, sepsis, abscess, or confirmed osteomyelitis rather than colonization.