After initial examination , complete spine examination and neurological assessment follows resuscitation. This detailed assessment begins with review of reports from the field.
This detail examination follows a different sequence in unresponsive and awake (cooperative) patients and and awake sequence of evaluation and intervention steps differs in unresponsive patients from awake and cooperative patients.
History
If patient is responsive, a detailed history is obtained regarding acute symptoms and past history.
For unresponsive patients, a past history is obtained from family members or available previous medical records.
Examination
The patient must be rolled on his or her side using a log-rolling maneuver. For this, The patient’s head and neck are supported by one person and the trunk by two to three other assistants. The head and trunk are then rolled in unison to facilitate the examination of spine by physician.
Following things are noted
- Areas of hemorrhage
- Abrasion
- Laceration
- Alignment of the spine
- Gross deformity
- Palpable gap in the spinous processes
- Tenderness
Trunk and abdomen are also examined for injury.
After local examination of the spine neurological examination is performed.
The neurological examination would vary in awake-cooperatibve and unresponsive patients.Awake and cooperative patients require a complete neurological examination. There are many methods and gradings to assess the neurological deficit whose basic purposes are following
- Presence of spinal shock
- Localization of the lesion level
- To determine whether injury is complete or in complete
- To determine if the injury fits into a particular pattern
This is achieved by detailed motor and sensory examination.
in case of unresponsive patient, radiographic studies are the primary modalities for identifying a spine injury in unresponsive patients. Spine injury precautions must be observed until the spine is cleared. If a spinal column injury is identified, the neurological deficit should be assessed. This can be done by serial neurological examinations, magnetic resonance imaging and sensory- or motor-evoked potentials.
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