ABC's certainly apply here but a careful neuro exam needs to be done promptly as well. Document the ASIA score.

If there are any signs of neurological deficit associated with a spine injury (even if there is no fracture...Spinal Cord Injury Without Radiological Abnormality...SCIWORA) there is a protocol of solumedrol that most centers use. It should be given within 8 hours of the injury. (See solumedrol in the meds section of this guide for details.)  Please be aware that there is some controversy around use of high dose steroids (EB Medicine Review by Peerless) for acute cord injury but that it is the usual practice at our centre now to use solumedrol for such patients.

One of the primary decisions in the spine injuries is the determination of stability. For C-spines you can follow the protocol in guidelines for evaluation of the cervical spine. The thoracic and lumbar areas will depend on the extent of the fracture on the CT...if you are not sure it is always better to be conservative. Guidelines are suggested by experts but not proven best by RCT evidence. See Cervical Spine Radiographs in the Trauma Patient  and Cervical Spine Moulage to learn more about acute care of potentially unstable spines.

Spinal cord damage can occur at the time of the injury, later on due to secondary to bone fragments in the canal causing additional cord trauma, or from hematomas compressing the cord. It is especially for suspected hematomas that an emergent MRI is needed.

Remember that skin ulcers and distended bladders can result if there are delays in the ER for turns and catheter insertions. If there is a cord lesion above C7, respiratory failure can arrive with little delay so watch the pCO2 as well. Autonomic dysreflexia can cause major bradycardia to the point that a temporary pacemaker may be needed. Cord injury patients need to be in monitored beds at first.

Links:
Cervical Spine Moulage
Cervical Spine Radiographs in the Trauma Patient
Guidelines for evaluation of the cervical spine


Evidence Footnotes:
1. reference