I. Overview Spinal cord injury is a common disease in orthopedics or spine surgery, mostly due to car accidents, falls, work-related injuries, sports activities and other spinal fractures or even dislocation, not only damage the stability of the spine, but also may compress the spinal cord, resulting in nerve damage. Spinal cord injuries are more serious and complex, often combined with thoracic, abdominal and pelvic organ injuries, handling difficulties, often serious complications, not only life-threatening, and often paraplegia, the prognosis is poor. In recent years, with aging, osteoporotic spinal compression fractures caused by minor trauma are also gaining attention, and this type of injury usually has a good prognosis, but requires active treatment of osteoporosis at the same time. Second, clinical manifestations 1, spinal fractures with a history of serious trauma, such as falls from height, heavy blows to the head, neck, shoulders and back, collapse accidents, traffic accidents, etc.. In the case of osteoporotic spinal compression fractures in the elderly, the trauma is generally mild, and sometimes there is no obvious history of trauma. The patient has localized pain, impaired mobility, inability to stand, and difficulty turning over. The fracture is locally painful with pressure or snap pain, sometimes with local swelling, subcutaneous bruising, and posterior protrusion deformity. Attention should be paid to the presence of combined thoracic, abdominal and pelvic organ injuries, and multiple injuries are prone to shock and life-threatening. Simple thoracolumbar fracture can also cause abdominal distension, abdominal pain and other symptoms, need to be distinguished from abdominal organ injuries. 2, combined spinal cord injury Spinal shock period, temporary inhibition of sensation, movement, reflex and autonomic function can occur when the spinal cord is traumatized, called spinal shock. During the period of spinal shock, flaccid paralysis occurs below the plane of injury, with loss of sensation and uncontrollable urination and defecation. 2 to 4 weeks later, spastic paralysis may evolve, manifesting as increased muscle tone, hyperactive tendon reflexes, and pathological signs. After the spinal shock period, the spinal cord is completely injured, with complete paralysis below the plane of injury, complete loss of deep and superficial sensation, and muscle strength grade 0. Incomplete spinal cord injury, manifesting as incomplete sensory and motor dysfunction. Delayed spinal cord injury, early after the injury without neurological symptoms, after several months or years, gradually appear spinal cord involvement, or even paralysis. There are many causes of delayed injury, such as spinal cord compression caused by disc herniation, spinal instability, angulation and displacement resulting in spinal cord wear, and spinal fracture with excessive bone scabs growing into the spinal canal to compress the spinal cord. Third, the examination and diagnosis 1, neurological examination Neurological examination should pay attention to the distinction between spinal shock, spinal cord incomplete injury and complete spinal cord injury. For the cauda equina injury, attention should be paid to check the perineal sensation and anal reflex. In addition to conventional frontal and lateral spine X-rays, CT examination should be performed to determine the degree of invasion of the displaced fracture mass into the spinal canal and to detect the bone mass or intervertebral discs protruding into the spinal canal. If the conditions allow, it is best to do MRI examination, which is extremely valuable for determining the status of spinal cord injury, it can show the edema and bleeding in the early stage of spinal cord injury, and can show various pathological changes of spinal cord injury. 3, evoked potential examination spinal cord injury should be performed when available evoked potential examination, to determine the extent of spinal cord injury is helpful. Fourth, treatment 1, first aid and transport improper first aid and transport can aggravate the spinal cord injury. Can not use a soft stretcher, to use a wooden board to carry, to make the pelvis, limbs overall axial rolling to the board. Prevent the trunk from twisting or flexing, disable the floor hold or one person to lift the head, one person to lift the leg method. For cervical spine injury, to hold the head and along the longitudinal axis slightly traction and torso consistent rolling. Observe whether the airway is obstructed during the move and remove it in time, check the changes in respiration, heart rate and blood pressure, if there are abnormalities need to be dealt with in time. 2. General treatment principles For stable spinal fractures without nerve injury, conservative treatment is mostly used, with external orthopedic brace fixation for 4 to 8 weeks, followed by rehabilitation training. For unstable spinal fractures and dislocations, especially when accompanied by nerve injury, surgery is used to facilitate the recovery of spinal cord injury and prevent complications. Spinal cord injury treatment principles: those with spinal cord compression should be released by surgery; those with spinal cord shock without signs of compression should be treated mainly with non-operative therapy and closely observed; complete spinal cord transection injuries should not be decompression surgery, but internal fixation is feasible for unstable fractures to facilitate care. 3, surgical treatment The principles of surgical treatment are to restore the function of the injured spinal cord as much as possible, to increase the recovery of reversible spinal cord injury; to rebuild the stability of the spine, to provide an ideal environment for neural recovery, to prevent progressive aggravation of the injury; to prevent complications and to reduce the morbidity and mortality rate. Posterior surgery in the thoracolumbar spine is less traumatic, less bleeding, and easier to operate than the anterior approach, and early posterior instrumentation fixation and repositioning can indirectly decompress the spinal canal. Nowadays, posterior short-segment fixation technique is quite mature, and for mild to moderate instability fractures, single-segment fixation via injured spine has also achieved satisfactory results, which has less impact on adjacent segments and is more in line with the concept of minimally invasive. With the continuous improvement of the lateral anterior decompression method of the posterior arch, the decompression effect has been significantly improved, and the clinical results of posterior decompression and implant fusion are no longer significantly different from those of anterior decompression and implant fusion by performing posterior posterolateral or even transvertebral foramina. Therefore, as long as the indications are properly selected, posterior decompression internal fixation is still the preferred method for thoracolumbar spine fracture surgery. The advantage of anterior surgery is that the anterior side of the spinal canal can be fully decompressed under direct vision, and the deformity can be corrected and fixed and fused at the same time, but anterior thoracolumbar surgery is traumatic and bleeding, therefore, the indications for anterior thoracolumbar surgery must be strictly controlled. At present, the indications for anterior surgery are: those with anterior spinal cord injury syndrome after spinal cord injury; those who still have residual pressure on the anterior compression after posterior surgery; and patients with incomplete paralysis caused by anterior compression. V. Rehabilitation Early and correct guidance and assistance to paraplegic patients for functional training, psychological rehabilitation to mobilize the patient’s subjective initiative and strengthen the will to overcome difficulties, so that they can adapt to life and work after discharge as soon as possible. Lifelong health self-management, such as urinary tract management, prevention of comorbidity management; functional training, including self-care; vocational training, so that they can earn their own living and contribute to society, etc.