Management of traumatic spinal cord injury in the Nordic countries: a multidisciplinary survey

TL;DR

This study surveyed how traumatic spinal cord injuries are managed across Nordic countries, finding mostly consistent practices aligned with international guidelines.

Contribution

The study provides a comparative analysis of clinical practices for traumatic spinal cord injury management across Nordic countries.

Findings

Clinical practices in key domains like pre-hospital care and surgery were largely consistent across Nordic centers.

Most surgeons considered preoperative MRI mandatory and performed early surgery within 24 hours of injury.

Variations were noted in steroid use and lumbar drain application in intensive care units.

Abstract

Management of traumatic spinal cord injury is complex and depends on a multidisciplinary approach involving pre-hospital services, spinal surgery, intensive care unit treatment and specialized rehabilitation. International clinical practice guidelines for the handling of these patients offer specific recommendations regarding transportation, radiological investigations, timing of surgery, intensive care management and rehabilitation. We performed a comprehensive multicenter survey to assess the agreement between the Nordic countries on the different aspects of traumatic spinal cord injury management.

Sequential, cross-sectional, structured survey comprising the key clinical domains (pre-hospital services, spinal surgery, intensive care management and rehabilitation) in all tertiary spine trauma centers in Sweden, Denmark, Norway, Iceland and Finland. Data are presented descriptively.

A total of 109 respondents from 22 Nordic centers were invited to take the survey, with a response rate of 90% (98/109). Overall, clinical practices were comparable within the domains. Prehospital services had similar practices for airway management, clinical spine clearance and patient transport. Preoperative magnetic resonance imaging was available to 33/35 of the spine surgeons (94%) on a 24/7 basis. This examination was considered mandatory prior to surgery by 66% (23/35) of the surgeons. Surgery was defined as early if performed within 24 h of the injury by all surveyed surgeons. Augmented blood pressure regimens were widely applied in the intensive care units, with mean arterial pressure targets varying between > 80 and > 90 mmHg. Postoperative thromboprophylaxis was administered within 48 h by all centers and rehabilitation policies were similar overall. Notable variations in practice were the occasional steroid administration and the use of lumbar drains in 54% (14/26) of intensive care units.

Although there is some variability in the current management of traumatic spinal cord injury in the Nordic countries at the center- and country-level, practices in most key clinical domains are similar and follow established international guidelines.

The online version contains supplementary material available at 10.1186/s13049-025-01349-8.