Can cervical spine erosion touching the spinal cord cause hypothermia?

Cervical Spine Erosion and Hypothermia

Cervical spine erosion touching the spinal cord does not directly cause hypothermia, but therapeutic hypothermia may be used as a treatment for acute cervical spinal cord injuries.

Relationship Between Cervical Spine Pathology and Temperature Regulation

• Cervical spine erosion that contacts the spinal cord typically causes neurological symptoms such as pain, sensory deficits, muscle weakness, and potentially paraplegia or quadriplegia, but not hypothermia 1.
• The primary neurological manifestations of cervical spine erosion with cord compression include spinal pain and neurologic deficits such as claudication, paraparesis, or paraplegia 1.
• Spinal cord injury from cervical spine pathology occurs in approximately 13% of patients following cervical spine decompression surgery 2.

Therapeutic Hypothermia for Spinal Cord Injury

• Therapeutic hypothermia is actually used as a treatment for acute cervical spinal cord injuries, not a symptom caused by them 3, 4, 5.
• Modest systemic hypothermia (33°C) for 48 hours has been studied as a neuroprotective strategy in patients with acute cervical spinal cord injury 3.
• In a case-controlled study, 43% of patients with complete cervical spinal cord injuries who received therapeutic hypothermia improved at least one ISNCSCI grade at follow-up 3.
• Therapeutic hypothermia works by reducing excitatory neurotransmitter release, decreasing free oxygen radical production, reducing post-ischemic edema, and stabilizing central nervous system blood flow 1.

Clinical Management Considerations

• Early intervention is critical in spinal cord injuries, with studies showing that early surgical decompression (< 24 hours) results in superior neurological recovery compared to delayed surgery 1.
• For patients with suspected cervical spine injury, maintaining spinal motion restriction by manually stabilizing the head is recommended to minimize movement of the head, neck, and spine 1.
• Risk factors for spinal injury include age over 65 years, motor vehicle accidents, falls from height, tingling in extremities, pain/tenderness in neck/back, sensory deficits, muscle weakness, altered mental status, and other painful injuries of head and neck 1.

Emerging Treatment Approaches

• Prehospital cooling initiated by paramedics and maintained for up to 24 hours in hospital has been studied for patients with spinal cord injury, showing feasibility and safety 5.
• A pilot study demonstrated that therapeutic hypothermia induced using ice-cold saline prehospital and maintained for 24 hours using mechanical devices appears to be feasible and safe in patients with SCI 5.
• A long-term follow-up of a professional football player with complete cervical spinal cord injury treated with systemic hypothermia showed excellent clinical results with only residual minor symptoms 6.

Complications and Considerations

• Complications of therapeutic hypothermia are predominantly respiratory and infectious in nature, but rates are similar to those observed in normothermic patients 7.
• Adverse events such as coagulopathy, deep venous thrombosis, and pulmonary embolism were not observed at higher rates in patients undergoing hypothermia 7.
• While promising, larger prospective randomized studies are needed before therapeutic hypothermia can become the standard of care for acute cervical spinal cord injury 6.

Pitfalls to Avoid

• Do not confuse hypothermia as a symptom of cervical spine erosion; it is a therapeutic intervention for spinal cord injury 3, 4.
• Avoid delays in treatment for cervical spine injuries with cord compression, as time-dependent interventions show better outcomes 1.
• Do not use immobilization devices for suspected spinal injuries unless properly trained, as their benefit in first aid has not been proven and they may be harmful 1.