Spine Trauma

What Is It?

Spine trauma results from a traumatic injury which involves the spinal column. This injury can lead to either injury to the spinal cord itself or to the spinal column bone and soft tissues or both. The spinal column includes both the bone and soft tissues (muscle, ligaments, etc.) of the spine as well as the nervous system tissues contained therein, including both the spinal cord and the spinal nerve roots which go in and out of the spinal cord.

Spinal trauma can either cause direct injury to these structures, as in the case of a direct blow or penetrating injury (gunshot wound, knife wound, etc.) to the neck or back, or indirect spine trauma injury. An indirect injury can occur if a patient has a trauma elsewhere which causes movement or pressure on the spine, causing injury. For example, a blow to the head may flex or extend the neck in such an extreme way as to produce a fracture or dislocation of the spine in the neck (the cervical spine). Likewise, a fall, landing on the buttocks, may cause pressure that causes injury to the lower spine (the lumbar spine).

What Types of Symptoms Are Typical?

Because every spine trauma injury is unique, the symptoms which occur after spine trauma cannot be generalized. The specific symptoms will depend on which structures are injured and which part of the spinal cord or spinal nerves are involved.

For example, some spine trauma may only cause bone or ligament damage without injuring the nervous system structures. In this case there may be no neurological symptoms but the patient may complain of neck or back pain only.

If the spinal cord is injured, the patient can experience a loss of normal neurological function in that area. This can include, most commonly, either sensory or motor symptoms, or both. Sensory impairment can present as numbness, tingling or pain in the distribution involved. Motor symptoms acutely include weakness or complete paralysis of the muscles involved. The location and extent of these symptoms depends completely on the location and severity of the injury to the spinal cord. A complete injury to the spinal cord at some level will lead to paralysis and numbness of all the parts of the body at the level of the injury as well as all areas below the level of injury. For example, an injury of the thoracic spinal cord will cause paraplegia, paralysis from the waist down including both legs. On the other hand, an injury high in the cervical spine in the neck can lead to quadriplegia, paralysis of all four extremities.

If spinal nerve roots are injured the area of skin and the muscles normally supplied by that nerve can become dysfunctional. For example, pain, numbness and muscle weakness in the normal distribution of that nerve can be common symptoms with damage of a nerve root. If the spinal cord itself is not injured, these symptoms may be isolated to this one area, not involving other areas of the body.

In many cases of spine trauma, there is a combination of these various types of injuries with spinal trauma.

The severity of symptoms following injury can vary tremendously and depend on the specific type, location and severity of injury. While some patients may be nearly asymptomatic, others may be completely quadriplegic and even require a ventilator to breath. Between these extremes, just about any amount of neurological compromise can be found depending on the specifics of each case.

How Is The Diagnosis Typically Made?

After a significant trauma, the spine is generally evaluated. This evaluation includes both an initial physical examination to determine if there are any obvious neurological deficits, including numbness or weakness of any part of the body, or any pain of the spinal column.

Following stabilization and this initial evaluation, the spine is further explored with various forms of imaging. Spine x-rays are generally taken which can help demonstrate any obvious spinal fractures, dislocations or misalignments of the spine. The spine is usually further evaluated by CT scan which can show better anatomic anatomy of the bones of the spinal column. After spine trauma, this can help reveal more subtle fractures or other structural changes of the spine.

Finally, if a patient has x-ray, CT or symptomatic evidence of a spine injury, they are generally further worked up with an MRI scan of the spine. This imaging study gives much higher resolution images of the spinal canal, including the spinal cord and spinal nerve roots themselves.

What Are Some Common Treatments?

After any significant trauma, such as a motor vehicle accident, significant falls, etc., a trauma patient is generally considered to have a spine injury until proven otherwise. For this reason, patients are immobilized until they can be taken to a hospital and evaluated. This includes laying the patient on a hard backboard and putting them in a neck collar to prevent movement of the spine which could make any injury they have worse.

After work-up, if a patient is found to have a spine injury, the treatment will depend entirely on the specific type and location of the injury. A complete discussion of these treatments for all forms of spinal trauma is beyond the scope of this site. In general, treatments can include many types of treatment including: observation, supportive management, immobilization (either external by braces or collars or internal by fusion), external or internal reduction, surgical decompression, etc.

In cases in which there is injury to the spinal cord itself causing neurological symptoms, most patients will receive high dose steroid drugs (methylprednisolone). While this treatment is sometimes controversial, it is generally used with the aim of decreasing swelling of the spinal cord and minimizing the ongoing injury.

Outcomes of treatment vary considerably depending on the specific type, location and severity of the injury. Each patient is different. Therefore, each patient's treatment and prognosis should only be discussed with their own treating physicians.

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Important Note: This site is not intended to offer medical advice. Every patient is different, and only your personal physician can help to counsel you about what is best for your situation. What we offer is general reference information about various disorders and treatments for your education.

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