Practical approach to acute traumatic paraplegia

1. Big picture

Acute traumatic paraplegia means sudden loss of motor function in both lower limbs after trauma, usually due to spinal cord injury. In the emergency setting, you must assume that the spine is unstable until proven otherwise.

For the exam, the key is not to give a long theoretical classification. The examiner wants a practical trauma workflow:

1. Do not move the patient incorrectly.
2. Stabilize airway, breathing, circulation.
3. Immobilize the whole spine.
4. Localize the spinal level clinically.
5. Recognize spinal shock versus neurogenic shock.
6. Do urgent CT/MRI.
7. Operate urgently if there is compression or instability.
8. Prevent secondary damage.

The most dangerous mistake is to focus on the paralysis and forget that the patient may die from airway obstruction, respiratory failure, hemorrhagic shock, cervical cord injury, or associated polytrauma.

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