Spinal cord injury refers to injury to the cord itself, whether this is complete or incomplete, and not simply a bony fracture of the spinal column. With spinal cord injury there may or may not be accompanying bony fracture or dislocation, and there will be a degree of neurological loss (of function).

Clinical management

• Involve physiotherapists immediately – particularly for chest management.
• Undertake accurate pre (and post) surgery American Spinal Injuries Association (ASIA) scoring.

In the early stages of rehabilitation consider management of:

• chest / airway / breathing
• Autonomic dysreflexia (AD) – see 8.d.ii
• Poikilothermia*
• bladder – see 8.d.iii
• bowel – see 8.d.iv
• pressure area care
• spasticity, spasm and posture management, including splinting
• orthostatic postural hypotension†
• neuropathic pain
• nutrition, including swallowing
• psychological support

* Poikilothermia – a term used to describe the fact that spinal cord injury affects a person´s ability to control their body temperature. Instead, the paralysed body adopts the temperature of the local environment. Poikilothermia occurs in patients with lesion above T1.

† Orthostatic postural hypotension – this occurs when there is an inability for the circulatory system to adapt to moving to an upright position. When an individual sits with the legs lowered, the body’s blood pools in the lower extremities. Blood pressure drops and the individual feels dizzy, light-headed or like they are going to faint. Rising slower will help, but elastic stockings and an elastic abdominal binder are necessary to assist the body with blood circulation.

Other actions

• Make referrals to the patient’s local area wheelchair services.
• Commence application for continuing healthcare (CHC) eligibility if appropriate (and patient consents).
• Refer to patient’s home area social services (if patient consents).
• Liaise with Spinal Injuries Association (SIA) peer support workers for support visits.
• Liaise with Department of Work and Pensions (DWP) advisor and legal services advisor as per patient/relatives wishes.