When a person receives a severe trauma (for instance, an injury from a fall or from a car crash), a possibility exists that the spine could be injured. When the trauma or injury is significant, x-rays of the cervical spine (neck) are obtained as a first step to rule out fractures. Sometimes it is necessary to x-ray the regions of the spine known as the thoracic (chest) and lumbar (lower back) spine as well.
Spine Fractures
The spine is a complex part of the body and may be fractured in a wide variety of ways. Managing these breaks depends on where they are located and to what degree the fractures may be stable or unstable.
To say that the spine is unstable as a result of a fracture means there has been some loss of the ligaments and bone that give it structural integrity. Potentially the spine could wobble and injure the spinal cord or nerve roots.
For purposes of evaluation the spine is usually divided into the anterior, middle, and posterior parts. In general, disruption of two of the three parts of the spine means that it is not stable and that movement would risk further injury to the spinal cord and/or nerve roots.
Treating Spine Injuries
Treatment of spine injury varies with the severity of the injury. Treatment ranges from bracing and/or bed rest for minor spine injuries to surgery for injuries that have made the spine unstable. With surgery techniques to stabilize the spine
"One version of a thoraco-lumbo-sacral orthosis (TLSO) brace offers good stability for injuries to the thoracic (chest) and lumbar (lower back) regions. It keeps the back straight by using specially designed front and back panels held together with Velcro."
Unstable Spine Injuries
Some potentially unstable neck injuries in which the bones still seem well aligned and straight can be treated by outfitting the patient with a halo device in the cervical neck region. For lumbar (back) injuries of this type, a brace--possibly with a leg extension--may be used.
" A halo device stabilizes injuries to the cervical (neck) area in which the bones still seem well aligned"
The most unstable spine fractures and lesions happen with twisting movements that occur with certain falls and roll-over vehicle crashes. In these cases, the surgeon may suggest the option of stabilizing surgery as the best choice for the patient.
The purpose of this surgery is to align the injured area of the spine by means of a stabilizing system consisting of implanted rods, screws, and hooks. This method has been shown in severe cases to give the best long-term results and to give the
patient the best chance of any future improvement that may possibly occur.
This surgery also allows the patient to be moved relatively soon and, therefore, avoid some of the complications usually associated with long-term bed rest such as deep vein thrombosis, pulmonary embolism, and pneumonia.
Spinal Cord Injuries
The spinal cord runs from the brain stem at the base of the skull down to the lower chest. Usually it stops at about the level of the kidneys, with only nerve roots present farther down. Spinal cord injuries, therefore, occur mostly with cervical (neck) or thoracic (chest) spine injuries.
Kinds Of Spinal Cord Injuries
A spinal cord injury can be complete or partial. It usually starts with a condition called spinal shock, and during this time the spinal cord doesn't function at all. This lasts about 48 hours, and then the spinal cord starts recovering.
If there is no recovery whatsoever after this time period, the injury is considered complete. This is usually an unfavorable sign in terms of recovery of function.
A spinal cord injury is called partial when some form of neurological function is preserved, no matter how small (sensory, movements, or sphincter function). The chance of improvement in this situation is much greater.
In the thoracic (chest) area, the spine is stabilized by the rib cage. Any fracture at that level that is bad enough to sever the spinal cord often causes a complete spinal cord injury. In this region, the blood supply to the spinal cord is poor and the spinal canal is narrow. Injuries of the spinal cord in the thoracic region produce paralysis in the legs and numbness below the level of the injury.
If the spinal cord injury occurs in the cervical (neck) area, it may produce paralysis of the upper extremities. The fibers going to the hands are usually located toward the center of the spinal cord and even a minor spinal cord injury could injure the center more than the edges. Often, therefore, even with partial paralysis in the upper extremities, the hands are often the parts of the body most affected.
"Cervical traction can be utilized to realign the cervical spine."
Treatment Of Spinal Cord Injury
The general line of treatment for spinal cord injury is to re-align and stabilize the spine if it is out of alignment. Some intravenous medication has been shown to improve the outcome of spinal cord injuries and is usually started as soon as possible.
In The Emergency Room
Initially when a patient with a traumatic injury arrives at the emergency room, they will be assessed by the emergency room physician and the trauma general surgeons. Many other physicians besides neurosurgeons may also be involved, depending on the various injuries. To have the spine evaluated, the patient will undergo a neurological examination, several x-rays of the head and spine, as well as scans (CT, MRI) if an area seems likely to have sustained injury.
In The Intensive Care Unit
If a spine injury is present, the patient will most likely be sent to the Intensive Care Unit and put in a rotating bed. Beds of this kind swing from side to side. They usually provide the best stability for the spine and decrease the chances of complications such as pneumonia, deep vein thrombosis in the legs, and subsequent pulmonary embolism. If the spine is out of alignment, some traction device may be used to try to realign it.
Although decompressing (to take the pressure off the spinal cord or nerve roots) and stabilizing surgery may be done immediately, in many instances it is delayed for a few days until everything stabilizes and the patient is out of the very critical initial period. The various treatment options will then be discussed with the patient and/or family.
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