Spinal Trauma

Approximately 2 per 100 000 of the population per year sustain a spinal injury. Of these, 50% involve the cervical region.

At impact, spinal cord damage may or may not accompany the bony or ligamentous damage. After impact, stability at the level of injury plays a crucial part in further management. Injudicious movement of a patient with an unstable lesion may precipitate spinal cord injury or aggravate any pre-existing damage.

MECHANISMS OF INJURY

The mechanism of injury helps determine the degree of stability:

STABLE

vertical compression e.g. object falling on to head or jumping from a height

STABLE

vertical compression e.g. object falling on to head or jumping from a height

hinge injury e.g. weight falling on back or blow to the forehead.

'Burst' fracture

Ligaments intact

Ligament disruption

(interspinous)

UNSTABLE

shearing injury e.g. fall from a height or road traffic accident. Often occurs in association with a rotational force.

Anterior wedge # (usually-, lumbar spine)

'Burst' fracture

Hyperextension injury - rupture of anterior longitudinal —■ ligament (stable in flexion)

Ligament disruption

(interspinous)

Anterior wedge # (usually-, lumbar spine)

Hyperextension injury - rupture of anterior longitudinal —■ ligament (stable in flexion)

(Usually cervical spine)

(Usually cervical spine)

In cervical spine where the apophyseal joints lie almost horizontally, dislocation may occur without a fracture. At other sites fracture/dislocation is always present. Initial assessment

The possibility of spinal injury must be considered at the scene of the accident and all movements and transportation of the patient undertaken with extreme caution especially when comatose. Most spinal injuries occur in conscious patients who complain of pain, numbness or difficulty with limb movements.

Examination may reveal tenderness over the spinous processes, paraspinal swelling or a gap between the spinous processes, indicating rupture of an interspinous ligament. Neurogenic paradoxical ventilation (indrawing of the chest on inspiration due to absent intercostal function) may occur with cervical cord damage.

Bilateral absence of limb reflexes in flaccid limbs, unresponsive to painful stimuli, indicates spinal cord damage (unless death is imminent from severe head injury.) Painless urinary retention or priapism may also occur.

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