Clinical Pathways
Clinical Pathways
Does not meet all criteria
Does not meet all criteria

Does not meet all criteria

View The Full Pathway

Action

  • Initiate or continue spinal motion restriction with cervical collar and adjuncts, as appropriate
  • Image the cervical spine with noncontrast CT; use 3- or 5-view plain film if CT unavailable (Class I)
  • Consider CTA if additional injuries or mechanism is high-risk by Denver Criteria (see Table 9) (Class II)

Decision

Is a spinal injury identified?

Yes

  • Do NOT administer methyl-prednisolone unless recommended by consultant (Class I)
  • Transfer to acute specialized SCI center (Class III)
  • Obtain neurosurgical or orthopedic spine consultation
  • Consider MRI to aid in defining injury (Class III)
  • Consider CTA in cases of:
    • Cervical spine fracture, especially C1-C3 or involving transverse foramen (Class II) or
    • If high risk by Denver criteria (see Table 9) (Class II)
  • Complete remainder of trauma evaluation. Admit or transfer to ICU (Class II) or spinal injury center (Indeterminate)

Background

image

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References
  1. Poonnoose PM, Ravichandran G, McClelland MR. Missed and mismanaged injuries of the spinal cord. J Trauma. 2002;53(2):314-320. (Retrospective review; 569 patients)
  2. “National Spinal Cord Injury Statistical Center, Facts and Figures at a Glance.” 2021. Accessed September 10, 2021. (Prospective longitudinal study; 34,734 patients)
  3. Kumar R, Lim J, Mekary RA, et al. Traumatic spinal injury: global epidemiology and worldwide volume. World Neurosurg. 2018;113:e345-e363. (Systematic review)
  4. Fehlings M, Singh A, Tetreault L, et al. Global prevalence and incidence of traumatic spinal cord injury. Clin Epidemiol. 2014:309. (Systematic review)
  5. Jain NB, Ayers GD, Peterson EN, et al. Traumatic spinal cord injury in the United States, 1993-2012. JAMA. 2015;313(22):2236. (Retrospective database study; 63,109 patients)
  6. Nicoll EA. Fractures of the dorso-lumbar spine. J Bone Joint Surg Am. 1949;31(3):376-394. (Review)
  7. Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res. 1984;&NA;(189):65-76. (Cohort study; 412 patients)
  8. Holdsworth FW. Fractures, dislocations, and fracture-dislocations of the spine. J Bone Joint Surg Am. 1963;45(1):6-20. (Review)
  9. Larson SJ. Vertebral injury and instability. Spinal Instability. Springer; 1993:101-137. (Textbook)
  10. Louis R. Spinal stability as defined by the three-column spine concept. Anatomia Clinica. 1985;7(1):33-42. (Review)
  11. Allen BL Jr, Ferguson RL, Lehmann TR, et al. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine. 1982;7(1):1-27. (Retrospective review; 165 cases)
  12. Harris JH, Edeiken-Monroe B, Kopaniky DR. A practical classification of acute cervical spine injuries. Orthop Clin N Am. 1986;17(1):15-30. (Guideline)
  13. Aarabi B, Walters BC, Dhall SS, et al. Subaxial cervical spine injury classification systems. Neurosurgery. 2013;72(suppl_3):170-186. (Guideline)
  14. Vaccaro AR, Koerner JD, Radcliff KE, et al. AOspine subaxial cervical spine injury classification system. Eur Spine J. 2016;25(7):2173–2184. (Prospective cohort; 10 spine surgeons)
  15. Walters BC, Hadley MN, Hurlbert RJ, et al. Guidelines for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery. 2013;60:10. (Clinical practice guideline)
  16. Aarabi B, Hadley MN, Dhall SS, et al. Management of acute traumatic central cord syndrome (ATCCS). Neurosurgery. 2013;72(suppl_3):195-204. (Systematic review)
  17. Alizadeh A, Dyck SM, Karimi-Abdolrezaee S. Traumatic spinal cord injury: an overview of pathophysiology, models and acute injury mechanisms. Front Neurol. 2019;10:282. (Review)
  18. Oyinbo CA. Secondary injury mechanisms in traumatic spinal cord injury: a nugget of this multiply cascade. Acta Neurobiol Exp (Wars). 2011;71:281-299. (Review)
  19. Allen AR. Surgery of experimental lesion of spinal cord equivalent to crush injury of fracture dislocation of spinal column: a preliminary report. JAMA. 1911;LVII(11):878. (Animal study)
  20. Gunby I. New focus on spinal cord injury. JAMA. 1981;245(12):1201-1206. (Review)
  21. Garfin SR, Shackford SR, Marshall LF, et al. Care of the multiply injured patient with cervical spine injury. Clin Orthop Relat Res. 1989;239:19–29. (Review)
  22. Theodore N, Hadley MN, Aarabi B, et al. Prehospital cervical spine immobilization after trauma. Neurosurgery. 2013;72(suppl_3):22-34. (Systematic review and guideline) DOI: 10.1227/NEU.0b013e318276edb1
  23. Bohlman HH. Acute fractures and dislocations of the cervical spine. An analysis of three hundred hospitalized patients and review of the literature. JBJS. 1979;61(8):1119–1142. (Case series; 300 patients)
  24. Reid DC, Henderson R, Saboe L, et al. Etiology and clinical course of missed spine fractures. J Trauma. 1987;27(9):980-986. (Prospective cohort; 253 patients)
  25. Toscano J. Prevention of neurological deterioration before admission to a spinal cord injury unit. Paraplegia. 1988;26(3):143-150. (Retrospective cohort; 123 patients)
  26. Manoach S, Paladino L. Manual in-line stabilization for acute airway management of suspected cervical spine injury: Historical review and current questions. Ann Emerg Med. 2007;50(3):236-245. (Systematic review)
  27. Hauswald M, Ong G, Tandberg D, et al. Out-of-hospital spinal immobilization: Its effect on neurologic injury. Acad Emerg Med. 1998;5(3):214–219. (Retrospective cohort study; 454 patients) DOI: 10.1111/j.1553-2712.1998.tb02615.x
  28. Oto B, Corey DJ, Oswald J, et al. Early secondary neurologic deterioration after blunt spinal trauma: a review of the literature. Acad Emerg Med. 2015;22(10):1200-1212. (Systematic review) DOI: 10.1111/acem.12765
  29. Hauswald M. A re-conceptualisation of acute spinal care. Emerg Med J. 2013;30(9):720-723. (Guideline)
  30. McDonald NE, Curran-Sills G, Thomas RE. Outcomes and characteristics of non-immobilised, spine-injured trauma patients: a systematic review of prehospital selective immobilisation protocols. Emerg Med J. 2016;33(10):732-740. (Systematic review) DOI: 10.1136/emermed-2015-204693
  31. Ham W, Schoonhoven L, Schuurmans MJ, et al. Pressure ulcers from spinal immobilization in trauma patients: a systematic review. J Trauma Acute Care Surg. 2014;76(4):1131–1141. (Systematic review)
  32. Núñez-Patiño RA, Rubiano AM, Godoy DA. Impact of cervical collars on intracranial pressure values in traumatic brain injury: a systematic review and meta-analysis of prospective studies. Neurocrit Care. 2020;32(2):469-477. (Systematic review and meta-analysis; 86 patients)
  33. Purvis TA, Carlin B, Driscoll P. The definite risks and questionable benefits of liberal pre-hospital spinal immobilisation. Am J Emerg Med. 2017;35(6):860-866. (Systematic review)
  34. Maarouf A, McQuown CM, Frey JA, et al. Iatrogenic spinal cord injury in a trauma patient with ankylosing spondylitis. Prehosp Emerg Care. 2017;21(3):390-394. (Case report)
  35. Maschmann C, Jeppesen E, Rubin MA, et al. New clinical guidelines on the spinal stabilisation of adult trauma patients – consensus and evidence based. Scand J Trauma Resusc Emerg Med. 2019;27(1):77. (Clinical guidelines)
  36. Kornhall DK, Jørgensen JJ, Brommeland T, et al. The Norwegian guidelines for the prehospital management of adult trauma patients with potential spinal injury. Scand J Trauma Resusc Emerg Med. 2017;25(1). (Systematic review, guideline)
  37. Fischer PE, Perina DG, Delbridge TR, et al. Spinal motion restriction in the trauma patient – a joint position statement. Prehosp Emerg Care. 2018;22(6):659-661. (Practice guidelines)
  38. Velopulos CG, Shihab HM, Lottenberg L, et al. Prehospital spine immobilization/spinal motion restriction in penetrating trauma: a practice management guideline from the Eastern Association for the Surgery of Trauma (EAST). J Trauma Acute Care Surg. 2018;84(5):736-744. (Clinical practice guideline)
  39. Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian c-spine rule for radiography in alert and stable trauma patients. JAMA. 2001;286(15):1841-1848. (Prospective cohort; 8924 patients)
  40. Kaesmacher J, Schweizer C, Valentinitsch A, et al. Osteoporosis is the most important risk factor for odontoid fractures in the elderly. J Bone Miner Res. 2017;32(7):1582-1588. (Retrospective cohort study; 5303 patients)
  41. Pray C, Feroz NI, Nigil Haroon N. Bone mineral density and fracture risk in ankylosing spondylitis: a meta-analysis. Calcif Tissue Int. 2017;101(2):182-192. (Systematic review and meta-analysis)
  42. Pandrich MJ, Demetriades AK. Prevalence of concomitant traumatic cranio-spinal injury: a systematic review and meta-analysis. Neurosurg Rev. 2020;43(1):69-77. (Systematic review and meta-analysis; 92,780 patients)
  43. Cleiman P, Nemeth J, Vetere P. A significant cervical spine fracture: think of the airway. J Emerg Med. 2012;42(2):e23-e25. (Case report)
  44. Eissa SA, Reed JG, Kortbeek JB, et al. Airway compromise secondary to upper cervical spine injury. J Trauma. 2009;67(4):692-696. (Retrospective cohort study; 625 patients)
  45. Hastings RH, Kelley SD. Neurologic deterioration associated with airway management in a cervical spine-injured patient. Anesthesiology. 1993;78:580-580. (Case report)
  46. Kuhn JE, Graziano GP. Airway compromise as a result of retropharyngeal hematoma following cervical spine injury. J Spinal Disord. 1991;4(3):264-269. (Case report)
  47. Como JJ, Sutton ERH, McCunn M, et al. Characterizing the need for mechanical ventilation following cervical spinal cord injury with neurologic deficit. J Trauma. 2005;59(4):912-916. (Retrospective cohort; 119 patients)
  48. Ledsome JR, Sharp JM. Pulmonary function in acute cervical cord injury. Am Rev Respir Dis. 1981;124(1):41-44. (Prospective cohort study)
  49. Ryken TC, Hurlbert RJ, Hadley MN, et al. The acute cardiopulmonary management of patients with cervical spinal cord injuries. Neurosurgery. 2013;72(suppl_3):84-92. (Systematic review and guideline)
  50. Wilson JR, Cadotte DW, Fehlings MG. Clinical predictors of neurological outcome, functional status, and survival after traumatic spinal cord injury: a systematic review. J Neurosurg. 2012;17(Suppl1):11-26. (Systematic review)
  51. Galeiras Vázquez R, Rascado Sedes P, Mourelo Fariña M, et al. Respiratory management in the patient with spinal cord injury. Biomed Res Int. 2013;2013:1-12. (Review)
  52. Royster R, Barboi C, Peruzzi W. Critical care in the acute cervical spinal cord injury. Topics in Spinal Cord Injury Rehabilitation. 2004;9(3):11-32. (Review)
  53. Taylor MP, Wrenn P, O'Donnell AD. Presentation of neurogenic shock within the emergency department. Emerg Med J. 2017;34(3):157-162. (Retrospective cohort; 3069 patients)
  54. Ruiz IA, Squair JW, Phillips AA, et al. Incidence and natural progression of neurogenic shock after traumatic spinal cord injury. J Neurotrauma. 2018;35(3):461-466. (Retrospective cohort; 84 patients)
  55. Plurad DS, Talving P, Lam L, et al. Early vasopressor use in critical injury is associated with mortality independent from volume status. J Trauma. 2011;71(3):565-572. (Retrospective cohort; 1349 patients)
  56. Docimo S, Diggs L, Crankshaw L, et al. No evidence supporting the routine use of digital rectal examinations in trauma patients. Indian J Surg. 2015;77(4):265-269. (Retrospective cohort study; 111 patients)
  57. Guldner GT, Brzenski AB. The sensitivity and specificity of the digital rectal examination for detecting spinal cord injury in adult patients with blunt trauma. Am J Emerg Med.2006;24(1):113-117. (Retrospective cohort study; 1032 patients)
  58. Hadley MN, Walters BC, Aarabi B, et al. Clinical assessment following acute cervical spinal cord injury. Neurosurgery. 2013;72(suppl_3):40-53. (Systematic review and guideline)
  59. ASIA and ISCoS International Standards Committee. The 2019 revision of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI)—what’s new? Spinal Cord. 2019;57(10):815-817. (Practice guideline) DOI: 10.1038/s41393-019-0350-9
  60. Hoffman JR, Mower WR, Wolfson AB, et al. Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma. New Engl J Med. 2000;343(2):94-99. (Prospective cohort; 34,069 patients)
  61. Stiell IG, McKnight RD, Schull MJ, et al. The Canadian c-spine rule versus the NEXUS low-risk criteria in patients with trauma. New Engl J Med. 2003:9. (Prospective cohort; 8283 patients) DOI: 10.1056/NEJMoa031375
  62. Michaleff ZA, Maher CG, Verhagen AP, et al. Accuracy of the Canadian c-spine rule and NEXUS to screen for clinically important cervical spine injury in patients following blunt trauma: a systematic review. CMAJ. 2012;184(16):E867-E876. (Systematic review)
  63. Inaba K, DuBose JJ, Barmparas G, et al. Clinical examination is insufficient to rule out thoracolumbar spine injuries. J Trauma. 2011;70(1):174-179. (Prospective cohort; 884 patients)
  64. Inaba K, Nosanov L, Menaker J, et al. Prospective derivation of a clinical decision rule for thoracolumbar spine evaluation after blunt trauma: an American Association for the Surgery of Trauma multi-institutional trials group study. J Trauma. 2015;78(3):459-467. (Prospective cohort study; 3065 patients)
  65. Ryken TC, Hadley MN, Walters BC, et al. Radiographic assessment. Neurosurgery. 2013;72(suppl_3):54-72. (Systematic review and guideline)
  66. Rozzelle CJ, Aarabi B, Dhall SS, et al. Management of pediatric cervical spine and spinal cord injuries. Neurosurgery. 2013;72 Suppl 2:205-226. (Systematic review and guideline)
  67. Talbott JF, Huie JR, Ferguson AR, et al. MR imaging for assessing injury severity and prognosis in acute traumatic spinal cord injury. Radiol Clin North Am. 2019;57(2):319-339. (Review)
  68. Demaerel P. Magnetic resonance imaging of spinal cord trauma: a pictorial essay. Neuroradiology. 2006;48(4):223-232. (Review)
  69. Fehlings MG, Martin AR, Tetreault LA, et al. A clinical practice guideline for the management of patients with acute spinal cord injury: recommendations on the role of baseline magnetic resonance imaging in clinical decision making and outcome prediction. Global Spine J. 2017;7(3 Suppl):221S-230S. (Systematic review, guideline)
  70. Duane TM, Cross J, Scarcella N, et al. Flexion-extension cervical spine plain films compared with MRI in the diagnosis of ligamentous injury. Am Surg. 2010;76(6):595-598. (Retrospective cohort; 22,929 patients)
  71. Schuster R. Magnetic resonance imaging is not needed to clear cervical spines in blunt trauma patients with normal computed tomographic results and no motor deficits. Arch Surg. 2005;140(8):762. (Prospective cohort; 2854 patients)
  72. Harrigan MR, Hadley MN, Dhall SS, et al. Management of vertebral artery injuries following non-penetrating cervical trauma. Neurosurgery. 2013;72(suppl_3):234-243. (Systematic review and guideline)
  73. Biffl WL, Moore EE, Offner PJ, et al. Optimizing screening for blunt cerebrovascular injuries. Am J Surg. 1999;178(6):517-522. (Prospective cohort; 249 patients)
  74. Kim DY, Biffl W, Bokhari F, et al. Evaluation and management of blunt cerebrovascular injury: a practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2020;88(6):875-887. (Systematic review, meta-analysis, and clinical practice guideline)
  75. Tobert DG, Le HV, Blucher JA, et al. The clinical implications of adding CT angiography in the evaluation of cervical spine fractures: a propensity-matched analysis. J Bone Joint Surg Am. 2018;100(17):1490-1495. (Retrospective cohort; 2831 patients)
  76. McLeod ADM, Calder I. Spinal cord injury and direct laryngoscopy – the legend lives on. Br J Anaesth. 2000;84(6):705-709. (Review)
  77. Rosen P, Wolfe RE. Therapeutic legends of emergency medicine. J Emerg Med. 1989;7(4):387–389. (Review)
  78. Donaldson III WF, Heil BV, Donaldson VP, et al. The effect of airway maneuvers on the unstable C1-C2 segment: a cadaver study. Spine. 1997;22(11):1215-1218. (Cadaver study)
  79. Lennarson PJ, Smith DW, Sawin PD, et al. Cervical spinal motion during intubation: efficacy of stabilization maneuvers in the setting of complete segmental instability. J Neurosurg. 2001;94(2):265-270. (Cadaver study)
  80. Velmahos GC, Toutouzas K, Chan L, et al. Intubation after cervical spinal cord injury: to be done selectively or routinely? Am Surg. 2003;69(10):891. (Retrospective cohort; 68 patients)
  81. Criswell JC, Parr MJA, Nolan JP. Emergency airway management in patients with cervical spine injuries. Anaesthesia. 1994;49(10):900-903. (Cohort study; 393 patients)
  82. Shatney CH, Brunner RD, Nguyen TQ. The safety of orotracheal intubation in patients with unstable cervical spine fracture or high spinal cord injury. Am J Surg. 1995;170(6):676-680. (Prospective cohort; 81 patients)
  83. Suderman VS, Crosby ET, Lui A. Elective oral tracheal intubation in cervical spine-injured adults. Can J Anaesth. 1991;38(6):785-789. (Retrospective cohort; 150 patients)
  84. Holmes MG, Dagal A, Feinstein BA, et al. Airway management practice in adults with an unstable cervical spine: The harborview medical center experience. Anesth Analg. 2018;127(2):450-454. (Retrospective cohort study; 252 patients)
  85. Patterson H. Emergency department intubation of trauma patients with undiagnosed cervical spine injury. Emerg Med J. 2004;21(3):302-305. (Retrospective cohort study; 308 patients)
  86. Rhee KJ, Green W, Holcroft JW, et al. Oral intubation in the multiply injured patient: the risk of exacerbating spinal cord damage. Ann Emerg Med. 1990;19(5):511-514. (Retrospective cohort; 237 patients)
  87. Scannell G. Orotracheal intubation in trauma patients with cervical fractures. Arch Surg. 1993;128(8):903. (Retrospective cohort; 81 patients)
  88. Thiboutot F, Nicole PC, Trépanier CA, et al. Effect of manual in-line stabilization of the cervical spine in adults on the rate of difficult orotracheal intubation by direct laryngoscopy: a randomized controlled trial. Can J Anaesth. 2009;56(6):412-418. (Randomized trial; 200 patients)
  89. Muckart DJ, Bhagwanjee S, van der Merwe R. Spinal cord injury as a result of endotracheal intubation in patients with undiagnosed cervical spine fractures. Anesthesiology. 1997;87(2):418-420. (Case series; 2 patients)
  90. Robitaille A, Williams SR, Tremblay M-H, et al. Cervical spine motion during tracheal intubation with manual in-line stabilization: direct laryngoscopy versus Glidescopevideolaryngoscopy. Anesth Analg. 2008;106(3):935-941. (Randomized trial; 20 patients)

    91. ®

  91. Romito JW, Riccio CA, Bagley CA, et al. Cervical spine movement in a cadaveric model of severe spinal instability: a study comparing tracheal intubation with 4 different laryngoscopes. J Neurosurg Anesthesiol. 2020;32(1):57-62. (Cadaver study)
  92. Cabrini L, Baiardo Redaelli M, Filippini M, et al. Tracheal intubation in patients at risk for cervical spinal cord injury: a systematic review. Acta Anaesthesiol Scand. 2020;64(4):443-454. (Systematic review and meta-analysis; 1972 patients) DOI: 10.1111/aas.13532
  93. Sakles JC, Corn GJ, Hollinger P, et al. The impact of a soiled airway on intubation success in the emergency department when using the glidescope or the direct laryngoscope. Acad Emerg Med. 2017;24(5):628-636. (Prospective cohort; 644 patients)
  94. Driver BE, Prekker ME, Klein LR, et al. Effect of use of a bougie vs endotracheal tube and stylet on first-attempt intubation success among patients with difficult airways undergoing emergency intubation: a randomized clinical trial. JAMA. 2018;319(21):2179. (Randomized controlled trial; 757 patients)
  95. Squair JW, Bélanger LM, Tsang A, et al. Empirical targets for acute hemodynamic management of individuals with spinal cord injury. Neurology. 2019;93(12):e1205-e1211. (Prospective cohort; 92 patients)
  96. Evaniew N, Mazlouman SJ, Belley-Côté EP, et al. Interventions to optimize spinal cord perfusion in patients with acute traumatic spinal cord injuries: a systematic review. J Neurotrauma. 2020;37(9):1127-1139. (Systematic review)
  97. Inoue T, Manley GT, Patel N, et al. Medical and surgical management after spinal cord injury: vasopressor usage, early surgerys, and complications. J Neurotrauma. 2014;31(3):284-291. (Retrospective cohort study; 131 patients)
  98. Squair JW, Bélanger LM, Tsang A, et al. Spinal cord perfusion pressure predicts neurologic recovery in acute spinal cord injury. Neurology. 2017;89(16):1660-1667. (Prospective cohort; 92 patients)
  99. Kasotakis G, Sideris A, Yang Y, et al. Aggressive early crystalloid resuscitation adversely affects outcomes in adult blunt trauma patients: an analysis of the Glue Grant database. J Trauma. 2013;74(5):1215-1222. (Retrospective cohort; 1754 patients)
  100. Wood GC, Boucher AB, Johnson JL, et al. Effectiveness of pseudoephedrine as adjunctive therapy for neurogenic shock after acute spinal cord injury: a case series. Pharmacotherapy. 2014;34(1):89-93. (Case series; 38 patients)
  101. Bracken MB, Shepard MJ, Collins WF, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury: results of the second national acute spinal cord injury study. N Engl J Med. 1990;322(20):1405-1411. (Randomized controlled trial; 487 patients) DOI: 10.1056/NEJM199005173222001
  102. Ahuja CS, Schroeder GD, Vaccaro AR, et al. Spinal cord injury—what are the controversies? J Orthop Trauma. 2017;31(4):S7-S13. (Review)
  103. Bracken MB. Steroids for acute spinal cord injury. Cochrane Database Syst Rev. 2012 Jan 18;1(1):CD001046. (Cochrane review; 8 randomized controlled trials)
  104. Cotler HB, Miller LS, DeLucia FA, et al. Closed reduction of cervical spine dislocations. Clin Orthop Relat Res. 1987(214):185-199. (Case series; 24 patients)
  105. Gelb DE, Hadley MN, Aarabi B, et al. Initial closed reduction of cervical spinal fracture-dislocation injuries. Neurosurgery. 2013;72(suppl_3):73-83. (Systematic review and guideline)
  106. Fehlings MG, Vaccaro A, Wilson JR, et al. Early versus delayed decompression for traumatic cervical spinal cord injury: results of the surgical timing in acute spinal cord injury study (STASCIS). PLoS ONE. 2012;7(2):e32037. (Prospective cohort trial; 313 patients)
  107. ter Wengel PV, Martin E, De Witt Hamer PC, et al. Impact of early (<24 h) surgical decompression on neurological recovery in thoracic spinal cord injury: a meta-analysis. J Neurotrauma. 2019;36(18):2609-2617. (Systematic review and meta-analysis; 1075 patients)
  108. Wilson JR, Tetreault LA, Kwon BK, et al. Timing of decompression in patients with acute spinal cord injury: a systematic review. Global Spine J. 2017;7(3_suppl):95S-115S. (Systematic review)
  109. ter Wengel PV, De Witt Hamer PC, Pauptit JC, et al. Early surgical decompression improves neurological outcome after complete traumatic cervical spinal cord injury: a meta-analysis. J Neurotrauma. 2019;36(6):835-844. (Systematic review and meta-analysis; 1126 patients)
  110. Phillips WA, Hensinger RN. The management of rotatory atlanto-axial subluxation in children. J Bone Joint Surg Am. 1989;71(5):664-668. (Case series; 23 patients)
  111. Powell EC, Leonard JR, Olsen CS, et al. Atlantoaxial rotatory subluxation in children. Pediatr Emerg Care. 2017;33(2):6. (Prospective case control study; 1600 patients)
  112. Pang D, Li V. Atlantoaxial rotatory fixation: Part 2—new diagnostic paradigm and a new classification based on motion analysis using computed tomographic imaging. Neurosurgery. 2005;57(5):941-953. (Prospective cohort; 40 patients)
  113. Pang D. Spinal cord injury without radiographic abnormalities in children. J Neurosurg. 1982;57:16. (Case series; 24 patients)
  114. Gao L, Peng Y, Xu W, et al. Progress in stem cell therapy for spinal cord injury. Stem Cells Int. 2020;2020:1-16. (Review)
  115. Curtis E, Martin JR, Gabel B, et al. A first-in-human, phase 1 study of neural stem cell transplantation for chronic spinal cord injury. Cell Stem Cell. 2018;22(6):941-950. (Clinical trial)
  116. Maharaj MM, Hogan JA, Phan K, et al. The role of specialist units to provide focused care and complication avoidance following traumatic spinal cord injury: a systematic review. Eur Spine J. 2016;25(6):1813-1820. (Systematic review)
  117. Theodore N, Aarabi B, Dhall SS, et al. Transportation of patients with acute traumatic cervical spine injuries. Neurosurgery. 2013;72(suppl_3):35-39. (Systematic review and guideline)

Spinal injury not identified
Spinal injury not identified
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