OR2.8 | Spine Injury Mobilisation Principles — Summary & Reflection

KEY TAKEAWAYS

Spinal injuries result from five main mechanisms — flexion, axial compression, flexion-rotation, extension, and distraction — each producing characteristic fracture patterns. The mechanically vulnerable transition zones (cervicothoracic and thoracolumbar junctions) are most commonly affected. The ASIA Impairment Scale grades SCI completeness (A-E); the single most important test is sacral sparing (S4-S5 preservation = incomplete injury). TLICS scores morphology, posterior ligamentous complex status, and neurological status to guide conservative (≤4) versus surgical (>4) management. Incomplete cord syndromes (central, Brown-Séquard, anterior cord) each carry specific prognostic and mechanistic significance. Neurogenic shock (hypotension + bradycardia + warm peripheries) differs from haemorrhagic shock and requires vasopressors rather than aggressive fluid loading. Safe mobilisation demands the log-roll technique with a minimum of four people, led by the most experienced clinician at the head maintaining manual in-line stabilisation and commanding all movements as a unit. Spinal cord precautions must be maintained until radiologically and clinically cleared. Definitive management includes MAP maintenance ≥85 mmHg, bladder and bowel care, DVT prophylaxis, early rehabilitation, and surgical decompression/stabilisation when indicated. High-dose methylprednisolone is no longer recommended as standard of care.

REFLECT

You are a house officer on the orthopaedic ward. You receive a new admission — a 38-year-old construction worker with a T4 burst fracture, ASIA D (incomplete). The nursing staff ask you about mobilisation: the patient is extremely anxious and wants to sit up. The physiotherapist has asked for orders. The neurosurgeon has written 'conservative management — TLSO' in the notes but has not clarified mobilisation. Reflect on: (1) What information do you need before writing a mobilisation order? (2) What does ASIA D mean in terms of prognosis and what should you tell the patient? (3) How will you safely supervise his first transfer from bed to chair? (4) What is the most important preventable complication in the first 48 hours, and how will you specifically prevent it?