Acute traumatic spinal cord and cauda equina injuries: Physiological and clinical basis of a fit-for-purpose model of service delivery and methods of management that led to the healthy survival of patients

Traumatic Spinal Injuries can present with or without neural tissue damage depending on the force of the impact and its direction.

The principles, methods of management of the injured spine as well as the Model of Service Delivery to patients with or without neural tissue damage are very different. Inadequate management is likely to have an impact not only on the neurological but also the medical and non-medical outcomes.

Traumatic Spinal Cord and Cauda Equina Injuries (tSCCEI) are the rarest of all life threatening and life changing injuries. Their incidence ranges between 1-5/100,000 population/year).
Their medical, physical, psychological, social, financial, vocational, environmental & matrimonial effects also impact the community and the society at large.

The combination of small incidence (10-50/million population), consequent multi-system physiological impairment and malfunction, sensory impairment/loss, multiple disabilities and range of non-medical effects impose challenges to patients and clinicians alike. 
This challenge is magnified during the period of instability of the physiological impairment during the transitional stage between the absence of spinal and autonomic reflexes (shock) and the full return of these reflexes. This period can last up to twelve weeks during which the patient and the neurological status are at a much higher risk of a range of systemic and local complications.   It is important to appreciate that Systemic complications before the full return of reflexes can result in further damage to the injured and Physiologically Unstable Neural Tissues and cause neurological deterioration, delays and poor recovery as well as morbidity and potential mortality.

Prior to WWII the majority of patients with acute (tSCCEI) died. For over 3 Centuries prior to WWII however there was no shortage of Clinicians who experimented with various methods of management of the injured bony spine in the hope of improving outcome. Sadly all their efforts were wasted and patients did not survive.  

Guttmann during WWII and subsequently the first and second generations of Spinal Cord Injury Specialists demonstrated that almost all complications can be prevented or diagnosed and treated before neurological deterioration, morbidity or mortality occur. This can only be achieved  by a comprehensive Model of Service Delivery which ensures simultaneous adequate management of the injured spine and  each of the medical and non-medical   effects of cord damage and the management is provided  by a knowledgeable, well-trained, well-coordinated experienced team of clinicians and health care professionals.  They demonstrated that with this system many patients improved neurologically and this improvement was significant in many.