1241 - Importance of Physiatry Consults in Acute Trauma: A Case of Non-Contiguous Spinal Cord Injury

Case Diagnosis: Incomplete C5 and Complete T4 spinal cord injury

Case Description: A 49-year-old male presented to the emergency department following an overturned truck accident. Initial exam revealed bilateral lower extremity flaccid paralysis, paresthesia below the T4 dermatome, and diminished rectal tone. CT thoracic spine showed comminuted impacted fractures and anterolisthesis of T4-T5. CT of the lumbar and cervical spine were unremarkable. Neurosurgery emergently took the patient for a T3-T5 laminectomy, T2-T7 posterior spinal instrumentation and fusion, T4-T5 open reduction and internal fixation. Physiatry was consulted following surgery, with post-operative evaluation revealed right upper extremity numbness, poor right grip strength, and positive Hoffman's on right side. Due to concern for undiagnosed cervical spinal cord injury, MRI cervical spine was ordered, which showed traumatic large disc herniation at C5-6 with severe stenosis. Patient subsequently underwent cervical discectomy and fusion of C5-6.

Discussions: This case illustrates the importance of physiatry as part of a multidisciplinary evaluation of acute trauma. A non-contiguous spinal cord injury was missed until Physiatry evaluation prompted further imaging. Non-contiguous spinal cord injuries occur in up to 28% of cervical spinal cord trauma cases. Delayed diagnosis could result in neurological deterioration and poor rehabilitation outcomes. In addition to diagnostic considerations, early physiatry consultation in acute trauma patients is associated with shorter acute care length of stay, fewer complications, and decreased mortality at 30 days. Physiatry should be consulted early in acute trauma, helping to supplement diagnostic precision and provide proactive rehabilitation planning.

Conclusions: This case supports the importance of physiatry in favorable outcomes in acute trauma patients. According to 2022 trauma center standards published by ACS, Standard 4.25, level I and II trauma centers must have physiatrists on staff. Future research should be done on patient outcomes with early physiatry consultation in the acute trauma setting.