MRI for acuity and marrow edema confirmation when needed
Analgesia precautions
Lower opioid starting doses
Delirium risk monitoring
Disposition bias toward admission
Mobility decline risk
Falls risk
Social supports assessment
Pediatrics
Mechanism patterns
Sports collision
MVC with lap belt risk
Flexion distraction injury suspicion
Seatbelt sign correlation
Abdominal injury association
Imaging strategies
Radiation minimization
CT only when indicated
MRI consideration for ligamentous injury when feasible
Neurologic exam adaptations
Age appropriate strength assessment
Sphincter function history from caregivers
Background
Epidemiology
Thoracolumbar junction vulnerability
T11 to L2 as common injury region
Transition zone biomechanics increasing fracture risk
Mechanism distribution
High energy trauma as common cause in younger patients
Low energy falls as common cause in older adults with osteoporosis
Non contiguous fractures risk
Multilevel injury possible in high energy trauma
Whole spine screening consideration in polytrauma
Pathophysiology
Column concepts
Anterior column
Vertebral body anterior portion
Anterior longitudinal ligament
Middle column
Posterior vertebral body portion
Posterior longitudinal ligament
Posterior column
Posterior elements
Posterior ligamentous complex
Stability determinants
Posterior ligamentous complex integrity
Degree of vertebral body comminution
Translation and rotation indicating gross instability
Neurologic injury mechanisms
Canal compromise from retropulsion
Distraction stretch injury
Vascular hypoperfusion injury
Epidural hematoma compression
Therapeutic Considerations
Non operative principles
Stable fracture patterns
Intact PLC
No significant translation
Pain control enabling mobilization
Brace selection individualized
Operative principles
Restore stability
Prevent progression of deformity
Enable early mobilization
Decompression when neurologic compromise
Timing urgency with progressive deficit
Perfusion strategy in acute spinal cord injury
MAP augmentation rationale
Improve spinal cord perfusion pressure
Reduce secondary injury cascade
Evidence quality limitations
Class III evidence basis in older guidelines
Risk of cardiac ischemia and arrhythmias with vasopressors
Steroid therapy controversy
Weak recommendation framework in some guidelines
Adverse event burden influencing many emergency medicine positions
Patient Discharge Instructions
copy discharge instructions
Stable thoracic or lumbar fracture after imaging
Brace use if prescribed
Wear schedule per spine service
Skin checks twice daily
Activity limits
No heavy lifting
Avoid bending twisting
No high risk sports
Pain control plan
Acetaminophen dosing schedule
NSAID plan if safe
Opioid only if prescribed
Constipation prevention if opioid
Hydration
Laxative regimen
Follow up
Spine clinic appointment timeframe
Repeat imaging plan if ordered
Return to ED immediately
New weakness
New numbness
Saddle anesthesia
Urinary retention
New bowel incontinence
Fever with worsening back pain
Uncontrolled pain preventing walking
New shortness of breath or chest pain after trauma
References
Clinical guidelines and society statements
Acute spinal cord injury hemodynamic management
MAP 85 to 90 mmHg for 7 days recommendation
Evidence limitations and adverse effect cautions
Steroids in acute traumatic spinal cord injury
Emergency medicine and neurosurgical guideline statements on risk benefit
Position statements discouraging routine high dose methylprednisolone
AO Spine thoracolumbar injury classification resources
Morphology framework Type A Type B Type C
Integration of neurologic status and modifiers
Thoracolumbar Injury Classification and Severity Score resources
Scoring domains and operative thresholds
Shared decision guidance for intermediate scores
Evidence based sources and textbooks
ATLS spine trauma principles
Spine motion restriction
Neurologic exam and reassessment
Reviews of TLICS and AO Spine classification performance
Reliability studies
Treatment threshold discussions
Trauma spine best practice guidelines
Imaging strategies
Perfusion and hypotension avoidance
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