Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXXIII: Wounds and Injuries of the Spinal Column and Cord
United States Department of Defense
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Reviewed
Four discriminators must be considered in the classification of spinal cord injuries: (1) the Type of injury (open or closed); (2) the Extent of the injury (complete versus incomplete); (3) the Location of the injury (cervical, thoracic, lumbar or sacral); and (4) the Degree of bony and ligamentous disruption (stable versus unstable).
To insure optimal preservation of neurological function during extrication and evacuation of the victim, several questions must be considered during the initial assessment. Might there be a spinal cord or column injury present? Does any neurological function persist below the level of the anatomical injury? What is the neurological level of the injury? Is it changing? Is the vertebral injury mechanically stable or unstable? If these questions cannot be answered and a spinal injury is suspected, the patient must be managed as if one existed.
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