Usually the result of trauma to the head or neck, spinal injuries (other than spinal cord damage) include fractures, contusions, and compressions of the vertebralcolumn. Spinal injuries most commonly occur in the twelfth thoracic, first lumbar, and fifth, sixth, and seventh cervical areas. The real danger from such injuries isassociated damage to the spinal cord.
Most serious spinal injuries result from motor vehicle crashes, falls, diving into shallow water, and gunshot and related wounds. Less serious spinal injuries typicallyare caused by improper lifting of heavy objects and by minor fails. Spinal dysfunction may also result from hyperparathyroidism and neoplastic lesions.
Spinal injuries can be complicated by spinal cord damage, resulting in paralysis and even death. The extent of cord damage depends on the level of injury to thespinal column. Autonomic dysreflexia, spinal shock, and neurogenic shock are complications of spinal injuries.
The patient’s history may reveal trauma, a neoplastic lesion, an infection that could produce a spinal abscess, or an endocrine disorder. The patient typicallycomplains of muscle spasms and back or neck pain that worsens with movement.
In cervical fractures, point tenderness may be present; in dorsal and lumbarfractures, pain may radiate to other body areas, such as the legs.Physical assessment (including a neurologic assessment) helps locate the level of injury and detect any spinal cord damage.
General observation of the patient reveals that he limits movement and activities that cause pain. Inspection reveals any surface wounds that occurred with the spinalinjury. Palpation can identify pain location, loss of sensation, deformity, and the presence of areflexia.If the injury damages the spinal cord, note that clinical effects range from mild paresthesia to quadriplegia and shock.
Spinal X-rays, myelography, and computed tomography scans and magnetic resonance imaging are used to locate the fracture and site of the compression.
The primary treatment after spinal injury is immediate immobilization to stabilize the spine and prevent cord damage; other treatment is supportive.Cervical injuries require immobilization by application of a hard cervical collar, sandbags on both sides of the patient’s head, or skeletal traction with skull tongs or ahalo device. When a patient shows clinical evidence of spinal cord injury, high doses of I.V. methylprednisolone are started.
Treatment of stable lumbar and dorsal fractures consists of bed rest on a firm surface (such as a bed board), analgesics, and muscle relaxants until the fracturestabilizes (usually in 10 to 12 weeks).
Later treatment includes exercises to strengthen the back muscles and a back brace or corset to provide support while walking.An unstable dorsal or lumbar fracture requires a plaster cast, a turning frame and, in severe fracture, laminectomy and spinal fusion.When the damage results in compression of the spinal column, neurosurgery may relieve the pressure. If the cause of compression is a neoplastic lesion,chemotherapy and radiation may relieve the compression by shrinking the lesion. Surface wounds that accompany the spinal injury require wound care and tetanusprophylaxis unless the patient was recently immunized.