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next up is phung ease on whos one of our neurosurgery attendings here and who has been with us for a couple years now came up from Texas and actually trained with us prior to that and hes going to give his perspectives on current evidence-based review on spinal cord injury thank you so my taco would be focused on the D acute spinal cord injury how do we manage at this time the incidence of the spinal fracture is about 64 over a hundred thousand population and the spinal cord injury occurs in about four you know its 100,000 population this is from the old national spinal cord injury data back in 1970s we dont know if theres any change over the time and also is estimated that the neurological deficit occurs in about ten to twenty five percent of all spinal column fracture patients the treatment of the spinal cord injury its and starts at the scene of the injury but today were going to focus on the in hospital management of this spinal cord injury including the M support the spina