Key messages

• Preservation of the airway, immobilization, oxygenation, ventilation when necessary, and resuscitation are necessary in managing patients with cervical cord injury.

• Administration of corticosteroids early and avoidance of hyperglycemia are part of management. Introduction

Spinal cord ischemia and disruption of the blood-cerebrospinal fluid barrier are the most important complications following the primary impact. Acute systemic hypotension and respiratory failure with spinal shock further reduce spinal cord perfusion and oxygen delivery. The mechanical stress of the initial impact and the reduced tissue perfusion induce accumulation of lactic acid, terminal membrane depolarization, aTp depletion, and release of excitatory neurotransmitters. The subsequent postsynaptic receptor stimulation triggers Ca2+ and Na+ influx which in turn activates catabolic enzyme reactions, finally leading to cellular necrosis. Therefore treatment of acute cervical spinal cord injury is divided into assessing the injury and immobilizing the spine, initial medical treatment, diagnostics and indications for surgical treatment, anesthesia, and peritraumatic and perioperative concepts of neuroprotection.

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