Anesthesia for Patients with Acute and Chronic Spinal Cord Injuries

Abstract

T he vertebral column is described as being composed of anterior, middle and posterior columns. These columns include bony and ligamentous structures which are both important for maintaining stability. An isolated anterior or posterior column injury will be stable but injuries involving more than one column are not. In the cervical spine, C1–C2 and C5–C7 cervical vertebrae are the most vulnerable to injury. These injuries are often unstable requiring immobilization to prevent further damage. Although injuries of the cervical vertebral column are more common, the spinal canal is relatively spacious at this level and cord injury is not inevitable. However, the mid-thoracic region is much less mobile and the small circular vertebral canal leaves little space around the spinal cord making cord compression more likely. The same principle of immobilization should be adhered to for thoracic and lumbar spine injuries, although, in general, these injuries are more stable. Instability allows actual or potential abnormal movement of one vertebral segment upon another, thereby compromising neural structures. Defining the stability of a vertebral column injury is important, as it may influence the anesthetic and surgical management. All spinal injuries should be treated as potentially unstable until proven otherwise.