title: Early Secondary Neurologic Deterioration After Blunt Spinal Trauma: A Review of the Literature.
abstract: OBJECTIVE
  The objectives were to review published reports of secondary neurologic deterioration in the early stages of care after blunt spinal trauma and describe its nature, context, and associated risk factors.
  
  
  METHODS
  The authors searched the MEDLINE, EMBASE, and CINAHL databases for English-language studies. Cases were included meeting the criteria age 16 years or older, nonpenetrating trauma, and experiencing neurologic deterioration during prehospital or emergency department (ED) care prior to definitive management (e.g., discharge, spinal clearance by computed tomography, admission to an inpatient service, or surgical intervention). Results were qualitatively analyzed for characteristics and themes.
  
  
  RESULTS
  Forty-one qualifying cases were identified from 12 papers. In 30 cases, the new deficits were apparently spontaneous and were not detected until routine reassessment. In 12 cases the authors did attribute deterioration to temporally associated precipitants, seven of which were possibly iatrogenic; these included removal of a cervical collar, placement of a halo device, patient agitation, performance of flexion/extension films, "unintentional manipulation," falling in or near the ED, and forced collar application in patients with ankylosing spondylitis. Thirteen cases occurred during prehospital care, none of them sudden and movement-provoked, and all reported by a single study.
  
  
  CONCLUSIONS
  Published reports of early secondary neurologic deterioration after blunt spinal trauma are exceptionally rare and generally poorly documented. High-risk features may include altered mental status and ankylosing spondylitis. It is unclear how often events are linked with spontaneous patient movement and whether such events are preventable.
authors.affiliation: University of New England, Portland, ME.
authors.forename: Brandon
authors.initials: B
authors.lastname: Oto
authors.affiliation: Northeastern University, Boston, MA.|Cataldo Ambulance Service, Inc., Somerville, MA.
authors.forename: Domenic John
authors.initials: DJ
authors.lastname: Corey
authors.affiliation: Ambulance Victoria, Victoria, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Oswald
authors.affiliation: Detroit, MI.
authors.forename: Derek
authors.initials: D
authors.lastname: Sifford
authors.affiliation: Department of Emergency Medicine, Bridgeport Hospital, Bridgeport, CT.
authors.forename: Brooks
authors.initials: B
authors.lastname: Walsh
mesh_terms: D006801:Humans; D009422:Nervous System Diseases / Q000209:etiology*; D012307:Risk Factors; D013124:Spinal Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000000981:diagnostic imaging