Spinal Injuries
(Department of Orthopaedics)
Made by : Arvind Jha, Anurag Tiwar
MBBS Batch 2021
MVASMC ,Ghazipur
Definition
• Spinal injuries encompass damage to the
vertebrae, spinal cord, intervertebral discs,
and associated ligaments.
• They may result in mechanical instability
and/or neurological impairment depending on
severity and location.
Epidemiology
• Most common in males aged 20–40 years due
to high-risk behavior and activities.
• Also increasingly prevalent in elderly
populations due to age-related falls and
osteoporosis.
• Major global burden with high morbidity and
long-term disability.
Etiology: Traumatic Causes
• Road traffic accidents: Account for over 50% of spinal
trauma globally.
• Falls from height: Common in construction workers, elderly,
and during recreational activities.
• Sports injuries: Include diving accidents, gymnastics, contact
sports.
• Industrial trauma and violence: Gunshots, stabbings,
machinery-related incidents.
Anatomy of the Spine
• The human spine has 33
vertebrae: 7 cervical, 12
thoracic, 5 lumbar, 5
fused sacral, and 4
coccygeal.
• The spinal cord ends at
L1–L2; below this, the
cauda equina continues.
Mechanism of Injury
• Hyperflexion: Common in frontal
collisions, causing compression
fractures.
• Hyperextension: Seen in rear-end car
accidents, may cause ligament tears.
• Axial compression: Falls landing on
feet or buttocks causing burst
fractures.
• Rotation and shearing forces: Cause
dislocations or fracture-dislocations.
Classification of Spinal Injuries
• Stable injuries: Do not threaten spinal cord
and allow limited motion.
• Unstable injuries: Risk of cord damage due to
disruption of vertebral integrity.
Clinical Features: Local
• Severe back or neck pain localized to the site
of injury.
• Swelling, bruising, or visible deformity.
Clinical Features: Neurological
• Motor weakness or paralysis below the injury
level.
• Sensory loss (pain, touch, temperature) in
dermatomal distribution.
Assessment
• Initial trauma assessment follows the ATLS protocol: Airway,
Breathing, Circulation, Disability, Exposure.
• Detailed neurological assessment uses ASIA (American Spinal
Injury Association) scoring for motor/sensory grading.
• Spinal shock: Temporary loss of reflexes, sensation, bowel
bladder control below injury level, may mask true injury
severity.
• Neurogenic shock: Hypotension and bradycardia due to
autonomic disruption (especially in cervical injuries).
Investigations
• X-rays: Basic anteroposterior and lateral views
to check alignment, fractures.
• CT Scan: Preferred for visualizing bony detail,
detecting complex fractures.
• MRI: Essential for soft tissue injury, spinal cord
compression, ligament damage, and
hemorrhage.
Phase 1 : Emergency Care
• Pre-hospital care includes spinal immobilization with cervical
collars and spine boards.
• Airway protection and oxygen support if cervical spine injury
suspected.
• Transport with spinal precautions to avoid further cord
damage.
• Prompt neurological evaluation and stabilization are critical.
• High-dose IV methylprednisolone as a bolusmay be used
within 8 hours of injury .
Phase 2 : Definitive Care
• Reduction : Skull Traction
Applied By Skull Calipers
(Crutchfield Tongs )
• Operation : Anterior Fusion
(Interbody Fusion) Or
Posterior Fusion ( Fusion Of
Spinal Process And Laminae)
Phase 3 :Rehabilitation
• Begins early and continues long-term; tailored
to level and extent of injury.
• Includes strengthening exercises, mobility
training.
Complications
• Acute: Neurogenic shock, respiratory failure,
bladder/bowel dysfunction.
• Chronic: Pressure ulcers, joint contractures,
osteoporosis, chronic neuropathic pain.
• Autonomic dysreflexia: Life-threatening
hypertension in injuries above T6, triggered by
bladder/bowel stimuli.
Prevention
• Primary: Enforce road safety, use helmets and
seatbelts, educate on fall prevention.
• Secondary: Early diagnosis and treatment of
minor injuries to prevent progression.
• Tertiary: Rehabilitation and community
integration to reduce long-term disability.
Summary
• Spinal injuries are complex and require immediate
multidisciplinary intervention.
• Understanding etiology, classification, and
management principles is crucial for optimal care.
• Early diagnosis and rehabilitation significantly
improve functional outcomes and quality of life.
