Identify the patient. Spinal injuries occur in;
- road traffic accidents. Head-on collisions and rear end shunts (whiplash injuries).
- falls from a height.
- sports injuries. especially rugby and diving accidents.
- birth injuries and non-accidental injuries NB. The patient who feels no pain when you examine his fractured tibia may be suffering from a spinal injury.
Assessment:
- attend to airway, breathing and circulation with cervical spine control (ABC of ATLS).
- stabilise the spine
- look for bruising of the face or forehead from an impact causing hyperextension. Log-roll the patient to look for local bruising, to feel the spinous processes and to feel for bony and/or soft tissue tenderness.
- neurological examination; - sensory levels - motor deficit - is there a partial lesion ? Indicated by; - Brown-Sequard picture - sacral sparing, assessed by anal and bulbocavernosus reflexes and anal tone on per rectum examination.
- X-ray examination which must include at least a lateral C-spine showing C1 to T1, AP views and odontoid peg views (taken through the open mouth).
GRADING. Spinal cord injuries can be awarded a Frankel grade: A: Complete lesion. B: Partial sensory lesion. No motor function. C: Variable sensory lesion. Useless motor function. D: Variable sensory lesion. Useful motor function. E: No lesion.