from: spinal cord compression

Evaluation and treatment of spinal cord compression

• Empiric spine immobilization (collar, board) for all trauma patients

• STAT MRI (at and above clinical spinal level, with gadolinium) or CT myelogram

• Emergent neurosurgical and/or neurology consultation. Urgent radiation therapy ↑ surgery for compression if due to metastatic disease (Lancet Oncol 2017;18:e720).

• Empiric broad-spectrum antibiotics ± surgery if c/f epidural abscess

• High-dose steroids depending on cause:

  Tumor: dexamethasone 16 mg/d IV (usually 4 mg q6 h) with slow taper over wks

  Trauma: methylprednisolone 30 mg/kg IV over 15 min then 5.4 mg/kg/h × 24 h (if started w/in 3 h of injury) or × 48 h (if started 3–8 h after injury) (Cochrane 2012:CD001046)