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Review Question - QID 7995

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QID 7995 (Type "7995" in App Search)
A 22-year-old man has an acute spinal cord injury after a diving accident. Preliminary radiographs reveal bilateral jumped facets at C6-7. Neurologic examination shows an incomplete spinal cord injury consistent with an ASIA B impairment grade. The patient is otherwise hemodynamically stable with no other injuries. Attempts at closed high weight reduction with tong traction have so far been unsuccessful. What is the most appropriate management at this time?

Continue a high weight closed reduction of the fracture-dislocation

1%

2/251

Urgent surgical intervention for reduction and decompression

82%

207/251

High-dose steroids for 48 hours before surgical stabilization

2%

4/251

Halo fixation

0%

1/251

Closed reduction under general anesthesia

14%

35/251

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Although there are no current standards for the timing of surgical intervention for acute spinal cord injuries there is increasing data, including animal studies, suggesting that early decompression and stabilization of an acute spinal cord injury can be beneficial. Continuing attempts at closed reduction is not advised given the failure of attempted high weight reduction. In light of the neurologic deficit, waiting 48 hours with or without steroid treatment is not recommended. Likewise, halo fixation without reduction of the dislocation should not be considered for definitive treatment. Closed reductions should not be performed under general anesthesia.

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