Clinical assessment following acute cervical spinal cord injury.

A cute traumatic spinal cord injury (SCI) affects 12 000 to 15 000 people in North America each year. The functional consequences of an acute SCI are variable; therefore, the initial clinical presentation of patients with an acute SCI is a key factor in determining triage, defining therapy, and predicting prognosis. The patient must be assessed with an accurate, consistent, and reproducible neurological assessment scale to define the acute SCI patient’s neurological deficits and to facilitate communication about patient status to caregivers. The early neurological status of an injury victim as described by an ideal neurological assessment scale should also have prognostic value for that patient’s neurological future. The comprehensive clinical assessment of the SCI patient should both accurately describe the patient’s neurological function (motor and sensory examinations) and generally predict that patient’s future relative abilities and/or impairment given the patient’s neurological status. Prognostic information provided by comparing current injury victims and the functional outcomes of historical patients with similar injuries is of value to patients and families. The evaluation of new therapies proposed for the treatment of acute SCI requires the use of accurate, reproducible neurological assessment scales and reliable functional outcome measurement tools to measure potential neurological improvement after therapy and, importantly, to determine its functional significance. Pain of the spinal cord, spinal column, or other orthopedic origin is often of clinical significance following acute SCI. Pain can be horribly debilitating, hindering patient performance and limiting functional abilities beyond that predicted by the patient’s neurological deficits. These 3 topics (neurological assessment, functional outcome, and pain associated with SCI) are the focus of this contemporary update on the Clinical Assessment Following Acute Spinal Cord Injury, previously produced and published by the Joint Section on Disorders of the Spine Mark N. Hadley, MD*