Spinal Injury

 

Spinal injury could involve soft tissues(muscles and ligaments), bones(vertebrae and discs), and neural tissue(spinal cord and nerves). It is important for primary assessment to establish the presence of an injury and initiate immediate treatment to avoid worsening either the primary or the secondary injury.

CAUSES OF SPINAL INJURIES

1. Road traffic accidents
2. Assaults
3. Blunt Injury
4. Penetrating injuries:sharp objects like knives,spears and firearms
5. Sports injury
6. Falling from a height

Bone injury could be stable or unstable and could be associated with neurological manifestation like paraplegia or quadriplegia depending on the level of injury. The injury could be a compression fracture with retropulsion of bone fragments into the spinal canal, causing spinal cord compression or complete transection of the cord.

Clinical Features

Conditions may present as part of the multiply injured patient and caution is needed not to overlook this condition. Neurogenic shock may be present. Neurogenic shock refers to the haemodynamic triad of hypotension, bradycardia,and peripheral vasodilation resulting from autonomic dysfunction and the interruption of sympathetic nervous system control in acute spinal cord injury.

Spine shock is defined as the complete loss of neurological function, including reflexes and rectal tone, below a specific level that is associated with autonomic dysfunction.

 

Investigations

1. Plain spinal radiographs: It is critical to maintain cervical stability during transfer and examination.
2. Scans in facilities where available.

Management

For level 4 and 5:

1. Ibuprofen 400mg orally or diclofenac 75mg IM STAT
2. If open wound: tetanus toxoid 0.5ml STAT and appropriate antibiotic.

• Care of the spinal column should be observed with application of a cervical collar or a hard board. Practice a log rolling procedure at all times. Spinal stabilizing should be provided during transportation. Resuscitation should continue  during transportation.
• Where facilities for surgical toilet for associated injuries are available, this may be performed prior to referral.
• Refer to a level 6 for a cute treatment and thereafter spinal injury unit for rehabilitation. Transfer should  be made even if the clinical manifestations of spinal injury are minor.

For level 6:

• Bone injuries addressed through surgery or other means
• Spinal decompression as appropriate for the individual case.
• Skin, bladder, and bowel care.
• Rehabilitation with physiotherapy, occupational therapy, prosthetic and orthotic fittings, etc.