The Orthobullets Podcast Foundations | Spine | Spinal Cord Injuries
Nov 29, 2025
Explore the fascinating world of spinal cord injuries and their underlying mechanisms. The discussion delves into the bimodal incidence rates and the distinction between primary and secondary injuries. Gain insights into neurogenic and spinal shock, plus how to manage initial evaluations both in the field and hospital settings. The podcast also covers medical management protocols, including DVT prophylaxis and indications for surgery. Real-life clinical cases highlight complex scenarios like autonomic dysreflexia and emphasize the limitations of ASIA scoring.
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Bimodal Epidemiology And Dual-Phase Injury
- Spinal cord injuries show a bimodal distribution affecting young trauma patients and older patients with degenerative narrowing.
- Primary injury is typically irreversible while secondary injury from ischemia and inflammation worsens outcomes.
Manage Neurogenic Shock Aggressively
- Recognize neurogenic shock by hypotension with relative bradycardia after acute spinal cord injury and treat with fluids and vasopressors.
- Monitor hemodynamics closely because loss of sympathetic tone causes vasodilation and pooling in the extremities.
Spinal Shock Hides True Neurology
- Spinal shock causes temporary flaccid areflexic paralysis and prevents accurate neurologic assessment until it resolves.
- The bulbocavernosus reflex return marks the end of spinal shock and the start of neurologic evaluation.