|
Medical Information
>> Types of Traffic Accident Injuries >>
Spine Injury
Alternative Names: Spinal cord
compression or injury; Compression of spinal cord
Definition: Spinal cord trauma
is damage to the spinal cord that results from direct injury
to the cord itself, or from indirect injury from damage to
the bones, soft tissues, and blood vessels surrounding the
spinal cord.
Causes, incidence, and risk factors:
Spinal cord trauma can be caused by any number of injuries
to the spine. They can result from motor vehicle accidents,
falls, sports injuries (particularly diving into shallow water),
industrial accidents, gunshot wounds, assault, and others.
A seemingly minor injury can cause spinal cord
trauma if the spine is weakened (such as from rheumatoid arthritis
or osteoporosis) or if the spinal canal protecting the spinal
cord has become too narrow (spinal stenosis) due to the normal
aging process.
Direct injury, such as cuts, can occur to the
spinal cord, particularly if the bones or the discs have been
damaged. Fragments of bone (from fractured vertebrae, for
example) or fragments of metal (such as from a traffic accident)
can cut or damage the spinal cord.
Direct damage can also occur if the spinal cord
is pulled, pressed sideways, or compressed. This may occur
if the head, neck, or back are twisted abnormally during an
accident or injury.
Bleeding, fluid accumulation, and swelling can
occur inside the spinal cord or outside the spinal cord (but
within the spinal canal). The accumulation of blood or fluid
can compress the spinal cord and damage it.
Spinal cord injuries occur in approximately
12,000-15,000 people per year in the U.S. About 10,000 of
these people are permanently paralyzed, and many of the rest
die as a result of their injuries. Most spinal cord trauma
occurs to young, healthy individuals. Males between ages 15
and 35 are most commonly affected.
Only about 5% of spinal cord injuries occur
in children. The fatality rate is higher with pediatric spine
injuries.
Older people with weakened spines (from osteoporosis)
may be more likely to have a spinal cord injury. Patients
who have other medical problems that make them prone to falling
from weakness or clumsiness (from stroke, for example) may
also be more susceptible.
Symptoms: Symptoms vary somewhat
depending on the location of the injury. Spinal cord injury
results in varying degress of weakness and sensory loss at
and below the injury. The pattern depends on whether the entire
cord is injured (complete) or only partially (incomplete).
The spinal cord doesn't go below the 1st lumbar
vertebra, so injuries at and below this level do not cause
spinal cord injury. However, they may cause "cauda equina
syndrome" -- injury to the nerve roots in this area.
CERVICAL (NEAR THE NECK) INJURIES
When spinal cord injuries occur near the neck,
varying degrees of symptoms can affect both the arms and the
legs:
- weakness, paralysis
- breathing difficulties (from paralysis of
the breathing muscles)
- spasticity (increased muscle tone)
- sensory changes
- numbness
- pain
- loss of normal bowel and bladder control
(constipation, incontinence, bladder spasms)
THORACIC (CHEST-LEVEL) INJURIES
When spinal injuries occur at chest level, varying
degrees of symptoms can affect the legs:
- weakness, paralysis
- breathing difficulties (from paralysis of
the breathing muscles)
- spasticity (increased muscle tone)
- sensory changes
- numbness
- pain
- loss of normal bowel and bladder control
- constipation
- incontinence
- bladder spasms
Injuries to the cervical or high thoracic cord
may also result in:
- abnormal blood pressure
- blood pressure fluctuates quickly and through
a wide range
- can be worsened with pain or bladder spasms
- abnormal sweating; trouble maintaining proper
temperature
Signs and tests: Symptoms may
develop immediately after injury or may occur gradually because
of fluid accumulation around the spinal cord or swelling within
the spinal cord itself. Spinal cord injury is a medical emergency
requiring immediate attention to minimize the long-term effects.
A neurologic examination indicates the location
of the injury, if it is not immediately evident. The reflexes
may be abnormal or may be absent in affected areas of the
body. There may be some recovery of reflexes after swelling
has subsided. Muscle spasticity is common as a late effect
of spinal cord injury.
- Spine X-rays may show fracture or damage
to the bones of the spine.
- A CT scan or MRI of the spine may pinpoint
the location and extent of spinal cord trauma and demonstrate
any compressive lesions like blood clots (hematomas).
- Rarely a myelogram (an X-ray of the spine
after injection of dye) may be necessary.
- Somatosensory evoked potential (SSEP) testing
or magnetic stimulation may determine if signals can get
through the spinal cord.
Treatment: A spinal cord trauma
is a medical emergency requiring immediate treatment
to reduce the long-term effects. The time between
the injury and treatment is a critical factor affecting the
eventual outcome.
Corticosteroids, such as dexamethasone or methylprednisolone,
are used to reduce swelling that may damage the spinal cord.
If spinal cord compression is caused by a mass (such as a
hematoma or bony fragment) that can be removed or brought
down before there is total destruction of the nerves of the
spine, paralysis may in some cases be reduced or relieved.
Ideally, corticosteroids should begin as soon as possible
after the injury.
Surgery may be necessary. This may include surgery
to remove fluid or tissue that presses on the spinal cord
(decompression laminectomy). Surgery may be needed to remove
bone fragments, disc fragments, or foreign objects or to stabilize
fractured vertebrae (by fusion of the bones or insertion of
hardware).
Bedrest may be needed to allow the bones of
the spine, which bears most of the weight of the body, to
heal.
Anatomic realignment is important. Spinal traction
may reduce dislocation and/or may be used to immobilize the
spine. The skull may be immobilized with tongs (metal braces
placed in the skull and attached to traction weights or to
a harness on the body).
Treatment will address muscle spasms, care of
the skin, and bowel and bladder dysfunction.
Extensive physical therapy, occupational therapy,
and other rehabilitation interventions are often required
after the acute injury has healed. Rehabilitation assists
the person in coping with disability that results from spinal
cord trauma.
Spasticity can be reduced by many oral medications,
medications that are injected into the spinal canal, or injections
of botulinum toxins into the muscles. It is important to treat
pain with analgesics, muscle relaxants, or physical therapy
modalities.
Expectations (prognosis): Paralysis
and loss of sensation of part of the body are common. This
includes total paralysis or numbness and varying degrees of
movement or sensation loss. Death is possible, particularly
if there is paralysis of the breathing muscles.
The level of injury affects the outcome. Injuries
near the top of the spine result in more extensive disability
(numbness and paralysis, breathing difficulty) than injuries
low in the spine.
Recovery of some movement or sensation within
one week usually indicates eventual recovery of most function,
although this may take 6 months or more. Losses that emain
after 6 months are more likely to be permanent.
Complications:
- paralysis (paraplegia, quadriplegia)
- loss of sensation
- loss of bladder control
- increased risk of urinary tract infections
- increased risk of chronic bilateral obstructive
nephropathy
- loss of bowel control
- loss of sexual functioning (male impotence)
- paralysis of breathing muscles
- increased risk of injury to numb areas of
the body
- pain
- complications of immobility:
- deep vein thrombosis
- pulmonary infections
- skin breakdown
- contractures
- shock
- extreme blood pressure fluctuations
- spasticity (late complication)
Calling your health care provider:
Call your health care provider if injury to the back or neck
occurs. Call 911 if there is any loss of movement or sensation.
This is a medical emergency!
Management of spinal cord injury begins
at the site of an accident with paramedics trained in immobilizing
the injured spine to prevent further damage to the nervous
system. Someone suspected of having a spinal cord
injury should NOT be moved without immobilization unless there
is an immediate threat.
If believe you have spinal injury as a
result of a traffic accident, it is important to visit a qualified
doctor to evaluate your injuries. Trying to "heal yourself"
could cause your body more harm.
>> Locate
a Chiropractic Specialist in your area |
