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A 40-year-old woman who was a restrained driver in a motor vehicle crash is evaluated in the emergency department. She is hemodynamically normal and found to be paraplegic at the level of T10. Which of the following are true regarding her evaluation and management?

a. Urgent surgical decompression of the spinal cord is indicated.

b. A thorough neurologic examination is unnecessary given the imaging findings.

c. Corticosteroids have no role in the management of spinal cord injury.

d. Prophylactic antibiotics are not recommended.

User Scaganoff
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Final answer:

Urgent surgical decompression might be needed, and a thorough neurological exam is necessary after a spinal cord injury. Corticosteroids remain controversial, and prophylactic antibiotics are not routinely recommended.

Step-by-step explanation:

The management of a spinal cord injury in a 40-year-old woman who is evaluated to be paraplegic at the level of T10 following a motor vehicle accident involves several considerations:

  • Urgent surgical decompression of the spinal cord may be indicated if imaging suggests that there is a compressive lesion that could be alleviated to improve neurological outcomes.
  • A thorough neurologic examination is essential, regardless of imaging findings, to establish a baseline for potential recovery and to detect any changes in neurological status.
  • Corticosteroids, like high-dose methylprednisolone, were previously used in the acute phase of spinal cord injury. However, their role has been questioned due to the risk-benefit ratio, and they are not universally recommended anymore.
  • Prophylactic antibiotics are generally not recommended in the absence of an open wound or other indications for infection.

Therefore, the statement that urgent surgical decompression is indicated in the case of compressive lesions is true. It is critical to perform a complete neurological examination, and corticosteroids are not a universally accepted treatment. Prophylactic antibiotics should be used based on clinical indications rather than routinely.

User Sergey Malyutin
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