Spinal injury

Spinal injury usually involves a fracture of the spinal column, which sometimes leads to spinal cord injury

• main causes of spinal injury are road traffic collisions, falls, violent attacks, sporting injuries and domestic incidents
• although spinal injury affects all ages, young and middle-aged men and older women tend to be the populations at highest risk
• approximately 1000 people sustain a new spinal cord injury each year in the UK (1)
  • these injuries are associated with serious neurological damage and can result in paraplegia, tetraplegia or death
  • currently there are no 'cures' for spinal cord injury and in the UK there are 40,000 people living with long-term disabilities as a result of such injuries.

1 in 10,000 individuals per year sustain a traumatic spinal injury. The vast majority however do not sustain a neurological injury.

In trauma to any part of the spine the question of neurological damage is paramount. Because of this, all unconscious patients requiring ATLS type management and all patients involved in accidents where spinal fracture is a possibility eg. road traffic accidents, are considered to have a fractured spine until proven otherwise. They are brought into hospital with a hard collar fitted to protect the cervical spine and taped to a spinal board.

After airway, breathing and circulation (ABC) are under control, X-rays are taken to exclude spinal fracture and a neurological examination undertaken.

If fractures are present they must be classified as stable or unstable. In STABLE fractures the spinal cord is rarely damaged and movement of the spine is safe. In UNSTABLE fractures the spinal cord may well have sustained damage and if not may do so is the patient is moved.

The stability of any spinal fracture can be assessed in terms of the 'three column spine' described by the French-Canadian Denis.

See also the section on neck injury.

Reference:

• NICE (February 2016).Spinal injury: assessment and initial management