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Spinal Trauma
Spine Trauma

Presentation

Cushing performed laminectomies within 24 hours on patients with immediate presentations-both complete and incomplete spinal cord lesions. [ncbi.nlm.nih.gov]

Initially, this may present as spinal shock, which is an acute physiological loss or depression of spinal cord function. [amboss.com]

Presentations of SCI have a bimodal distribution. Cases related to trauma in younger adults often involve higher velocity injury in a healthy spine. [trauma.reach.vic.gov.au]

We found a median delay between presentation and diagnosis was 3.7 days, and median delay between presentation and treatment of 5.6 days. [bmcpediatr.biomedcentral.com]

Entire Body System

  • Pain

    […] as well as for patients with severe pain and inability to function who have not gotten better after at least three to six months of non-surgical treatment. [ana-neurosurgery.com]

    but patients who are distracted by other painful injuries (eg, long bone fractures) or whose level of consciousness is altered by intoxicants or head injury may not complain of pain. 14. [slideshare.net]

    The severity of initial neck pain intensity is a predictor of long term pain severity.27,28 This may reflect the variable success of the wide range of therapies used to manage post-traumatic neck pain including physiotherapy, exercise, early mobilisation [racgp.org.au]

    More severe injuries can damage the spinal cord or nerve roots to cause paralysis or regional pain and weakness. [mdmercy.com]

    All four patients demonstrated spontaneous relief of pain within 2 weeks after injury. The pain was modified by transcutaneous stimulation in one case and by l-dopa in another case. [ncbi.nlm.nih.gov]

  • Falling

    Over the past several decades, the mean age of the spinal cord-injured patient has increased which is attributed to a substantially greater proportion of injuries related to falls in the elderly. [portal.research.lu.se]

    Spine trauma is damage to the spine caused from a sudden traumatic injury caused by an accidental fall or any other physical injury. [newwestsportsmedicine.com]

    Car accidents are a common cause of spinal injury, as are sports injuries and falls. [spineuniverse.com]

    The primary cause of spinal fractures is high-impact trauma, such as a car accident, a long fall, a sports accident, or a gunshot wound. [rushortho.com]

    This is largely due to a trauma injury that produces great force, such as a motor vehicle accident or hard fall, both of which are the leading causes of this injury. [ana-neurosurgery.com]

  • Weakness

    More severe injuries can damage the spinal cord or nerve roots to cause paralysis or regional pain and weakness. [mdmercy.com]

    Fusion includes stabilizing the bones of your spine (vertebrae) that are structurally weak or have too much abnormal motion. Usually, we implant titanium rods and screws into your back. [mountsinai.org]

    […] and symptoms of spinal trauma vary based on where the injury occurred, and can include: Difficulty breathing Difficulty controlling the bladder and bowels Difficulty controlling the legs Loss or decrease of feeling, muscle movement and reflexes Muscle weakness [childrens.com]

    While nerve injuries are not usually as devastating as spinal cord problems, pressure on many nerves at once (called cauda equina syndrome) is an emergency because long term leg weakness and bowel and bladder problems often results. [understandspinesurgery.com]

  • Inflammation

    Bleeding, swelling, inflammation, and fluid accumulation can cause additional damage over days or weeks. Medications can help reduce swelling and inflammation. [barrowneuro.org]

    Spine Trauma Treatments Your spine trauma specialist may recommend any of the following treatments: Immobilization (and possibly sedation) to stabilize the spine and prevent further injury to the spinal cord Medications to reduce inflammation and protect [comprehensivespine.weillcornell.org]

    If untreated, additional damage may occur from internal bleeding, swelling, inflammation, or fluid accumulation. Symptoms: Because trauma can affect the spine in many different places and ways, symptoms can vary. [orthopedicnj.com]

    Both ESR and CRP tests are often good indicators as to whether any inflammation is present in the body (the higher the level, the more likely it is that inflammation is present). [aans.org]

    During the weeks following the injury, bleeding, swelling, inflammation and fluid buildup in or near the spinal cord often cause further damage. [livescience.com]

  • Surgical Procedure

    Microdiscectomy is a minimally invasive procedure which involves removal of a portion of a slipped disc by a surgical instrument or LASER. [newwestsportsmedicine.com]

    The most common surgical procedures for spinal compression fractures are lumbar fusion and vertebroplasty/kyphoplasty. [athensbrainandspine.com]

    A broad range of image registration options and compatible imaging devices provides great freedom to the surgeon to tailor the surgical procedure and imaging devices. Trauma surgery typically requires immediate action. [brainlab.com]

    The surgical group received the minimally invasive mild decompression procedure, and the conservative group underwent the epidural steroid injection procedure. [cochranelibrary.com]

    But overall, the treatment goals for spinal trauma focus on 2 key components: Stabilize the spine Preserve the health of your spinal cord and spinal nerves To relieve compressed nerves, your spine surgeon may perform a decompression surgical procedure [spineuniverse.com]

Gastrointestinal

  • Vomiting

    Loss of bowel and bladder function If you are experiencing any of the following signs, you may be suffering from brain trauma: Loss of consciousness that may last anywhere from a few seconds to minutes State of confusion or disorientation Nausea or vomiting [kaweahdelta.org]

    Concerning symptoms (which may occur soon after the injury or hours later) include, confusion, loss of consciousness, nausea, vomiting, loss of movement or sensation, trouble with balance or walking, no bowel or bladder control or pain or pressure in [nicklauschildrens.org]

  • Diarrhea

    People who are sick with a Salmonella infection should drink extra fluids as long as diarrhea lasts. [cdc.gov]

    Your healthcare provider might advise you to call them if you have problems such as: Skin sores or infections Trouble breathing Fever, cough, or other signs of infection Severe headache Not urinating regularly or having severe diarrhea or constipation [hopkinsmedicine.org]

    Common causes are diarrhea, vomiting, peritonitis, diuretics and osmotic diuretic therapy ie glucose, urea, mannitol other causes are cirrhosis of liver and congestive cardiac failure[5],[7]. [jadweb.org]

Musculoskeletal

  • Neck Pain

    Delayed presentation of neck pain Cases of delayed neck pain following trauma should initially be assessed to exclude cervical spine injury as per acute presentations. [racgp.org.au]

    She presents to the ER complaining of localized neck pain and stiffness. On physical exam she has paraspinal tenderness in the cervical region. She has limited motion in all planes secondary to pain. [orthobullets.com]

    It usually produces pain in the back or neck; pain, weakness, or numbness in an arm or leg; and paralysis. Fractures, dislocations, deformity, or spinal cord injury also occur commonly with spinal trauma. [mountsinai.org]

    “If a person has neck pain, or is not fully awake, or there are other obvious signs of injury, tests such as CT scan, x-rays, and MRIs can be implemented to find out where we are. [orthopedicnj.com]

    Required one of the following: neck pain, or no neck pain + all of (injury above clavicles, non ambulatory and dangerous mechanism). Ian Stiells group generated a decision rule with sensitivity of 99.7% and specificity of 50.7 %. [canadiem.org]

  • Back Pain

    The goal of the surgery is to fuse and repair the fracture, eliminate back pain, and restore posture and ease of movement. The most common surgical procedures for spinal compression fractures are lumbar fusion and vertebroplasty/kyphoplasty. [athensbrainandspine.com]

    Symptoms of spinal fractures or dislocations vary, and may include: Neck or back pain. Pain, numbness, tingling or weakness in your arms or legs. Bladder or bowel problems. Partial or complete paralysis. [mercy.net]

    […] and/or numbness of arms or legs, incontinence of bowels and/or bladder Patients may initially have few symptoms, but eventually develop severe back pain. [aans.org]

    This type of collision or a fall while in the shower can cause low back pain, but the types of injuries seen are very different from a high speed collision in which the passenger is ejected from the car. [understandspinesurgery.com]

    This resulted in the use of spinal immobilization on the majority of trauma patients, regardless of mechanism of injury or presenting symptoms. 5,6 One review estimated that over 50% of trauma patients with no complaint of neck or back pain were transported [mdedge.com]

  • Low Back Pain

    This type of collision or a fall while in the shower can cause low back pain, but the types of injuries seen are very different from a high speed collision in which the passenger is ejected from the car. [understandspinesurgery.com]

    We excluded those with non‐specific low back pain and radicular pain secondary to primary pathological conditions other than congenital or degenerative LSS. [cochranelibrary.com]

    De-educate to re-educate: aging and low back pain. Aging Clin Exp Res 2017;29:1261–1269. Ailon T, Shaffrey CI, Lenke LG, Harrop JS, Smith JS. Progressive spinal kyphosis in the aging population. Neurosurgery 2015;77 Suppl 4:S164–S172. [jkoa.org]

    It can cause low back pain, weakness or paralysis in the lower limbs, loss of sensation, bowel and bladder dysfunction, and loss of reflexes. Unlike in conus medullaris syndrome, symptoms often occur on only one side of the body. [en.wikipedia.org]

Neurologic

  • Quadriplegia

    Level of injury Possible impairment Rehabilitation potential C2 - C3 Usually fatal as a result of inability to breathe Totally dependent for all care C4 Quadriplegia and breathing difficulty Dependent for all cares; usually needs a ventilator C-5 Quadriplegia [hopkinsmedicine.org]

    Although neurologically intact on initial workup, she developed precipitous quadriplegia and apnea in a delayed fashion. Tonsillar herniation with medullary compression and cerebellar infarction was diagnosed on magnetic resonance imaging. [ncbi.nlm.nih.gov]

    Paralysis is classified as either paraplegia, meaning a paralysis of the trunk, lower limbs, and some organs, or quadriplegia, in which the arms, hands, lower body, legs, and pelvic organs are all affected by the injury. [comprehensivespine.weillcornell.org]

  • Paresis

    It presents with spastic paresis, hyperreflexia, and continued sensory loss. Acute stabilization, a thorough neurological examination, and imaging is required for adequate diagnosis. [amboss.com]

    Lesions at the C5 level or higher lead to diaphragmatic paresis or paralysis, as the phrenic nerve arises from the C3-5 levels. [litfl.com]

    […] hands C8-T1 With transverse lesions, Horner's syndrome (ptosis, miotic pupils, facial anhidrosis), paralysis of legs T1-T12 Paralysis of leg muscles above and below the knee At T12 to L1 Paralysis below the knee Cauda equina Hyporeflexic or areflexic paresis [slideshare.net]

    Results in loss of position sense Cauda equina lesions due to lumbar fracture loss of bowel and bladder functions, with paresis of LMN type. sensory loss may be patchy plus radicular pain exacerbated by straight leg raising. [aic.cuhk.edu.hk]

Urogenital

  • Urinary Retention

    This is followed by a state of hypotension, flaccid paralysis, urinary retention, and fecal incontinence. The symptoms of spinal shock may last a few hours to several days/weeks. [ncbi.nlm.nih.gov]

    EFAST) — Nasogastric tube insertion — spinal patients are at risk of gastric distention — Indwelling catheter insertion — prevent urinary retention and bladder overdistention due to spinal inury; monitor urine output given the risk of hemorrhagic and [litfl.com]

Workup

Although neurologically intact on initial workup, she developed precipitous quadriplegia and apnea in a delayed fashion. Tonsillar herniation with medullary compression and cerebellar infarction was diagnosed on magnetic resonance imaging. [ncbi.nlm.nih.gov]

Treatment

Treatments Treatments plans will be based off of the overall health, age and severity of the fracture. [advocatechildrenshospital.com]

From diagnosis to rehabilitation, neurosurgeons at Kaweah Delta will be with you every step of the way through your brain or spinal trauma treatment. Schedule a consultation with your primary care doctor. [kaweahdelta.org]

This type of treatment is almost always urgent and non-elective, exclusively for victims of accident or assault. [metropolitan-neurosurgery.com]

The treatment of a spinal trauma patient does not end with hospital management. [ncbi.nlm.nih.gov]

After surgical treatment of the wound in the lumbar region at L5-S1 level due to trauma, the leakage of a transparent discharge had been observed, the nature of which was unclear; it was considered at this treatment stage to be injury to the right ureter [pediatricneurosciences.com]

Prognosis

There are several types of traumatic spinal cord injury 3-5 : spinal cord swelling spinal cord contusion/edema cord edema only: most favourable prognosis cord edema and contusion: intermediate prognosis cord contusion only: worse prognosis intramedullary [radiopaedia.org]

The prognosis is guarded for recumbent horses and cattle. [merckvetmanual.com]

These cases illustrate Cushing's dedication to and rapport with his patients, even in the face of a dismal prognosis. [ncbi.nlm.nih.gov]

References: [1] [2] [3] Complete spinal cord injury Prognosis In acute spinal cord injury ( spinal shock ), flaccid paralysis and a complete absence of reflexes occur below the injury. [amboss.com]

Etiology

Core Content Outline: Cervical Spine Injury Etiology Understand the most common etiologies of cervical spine injuries in children Know mechanisms and patterns of injury associated with cervical spine injuries in children Pathophysiology Understand the [reliasmedia.com]

Various etiologies, such as coagulation disorders and vascular malformations have been described [3,4,5,6,7,8,9]. [bmcpediatr.biomedcentral.com]

This activity provides a concise introduction to the care of these patients.[1] Etiology Spinal shock has been described initially in a patient with transected spinal cord and difficult to treat hypotension as a result of decreased sympathetic tone throughout [ncbi.nlm.nih.gov]

Subluxation may also be an asymptomatic complicating factor to those etiologic factors mentioned above. [chiro.org]

High blood glucose levels has been described as one of the most common etiology for translocational hyponatremia. [jadweb.org]

Epidemiology

Spinal cord injury in Manitoba: a provincial epidemiological study. J Spinal Cord Med. 2011;34(1):6-10. Cripps RA, Lee BB, Wing P, Weerts E, Mackay J, Brown D. [msjonline.org]

The global map for traumatic spinal cord injury epidemiology: update 2011, global incidence rate. Spinal Cord. 2014;52(2):110-6. [ Links ] 10 Devivo MJ. Epidemiology of traumatic spinal cord injury: trends and future implications. [scielo.br]

Epidemiological trends of spine trauma: An Australian Level 1 Trauma Centre Study. Global Spine J 2013; 3: 75–84. 13 Ackery A, Tator C, Krassiokov A. A global perspective on spinal cord injury epidemiology. [nature.com]

Epidemiological data were collected, along with data on injury mechanism, injury intent, toxicology screen results, primary payer, Injury Severity Score (ISS), hospital length of stay (LOS), discharge location, and mortality. [thejns.org]

Epidemiologic studies have found that the average age of a spinal cord injury patient is gradually increasing with an increase in the percentage of female patients, unlike in the 1980s when a typical spinal cord injury patient was a young male involved [journals.lww.com]

Pathophysiology

Pathophysiology, presentation and management of spinal cord injury. Surgery. 2015;33(6):238–47. Sekhon H.S. L, G. Fehlings M. Epidemiology, demographics, and pathophysiology of acute spinal cord injury. Spine. 2001;26(24S):S2–12. [medigraphic.com]

Perhaps such techniques would allow more insights into the ongoing pathophysiologic changes present in the acute and chronically injured spine. [ajnr.org]

Pathophysiology of spinal trauma The pathophysiological events in the human body following traumatic injury involve the participation of chiefly two mechanisms: the primary injury and secondary injury[2]. [jadweb.org]

Research endeavors in the realm of spinal cord injury recovery and regeneration research are expanding at a rapid pace as our understanding of spinal cord pathophysiology improves through basic science and clinical research. [journals.lww.com]

척수손상의 병리 및 병태생리 Pathology and pathophysiology of spinal cord injury >>> 479 21. 척추손상의 분류 및 응급처치 Classification and emergency care of spine injury >>> 489 22. 척추손상의 집중치료 Intensive care for spine injury >>> 509 23. [mdon.co.kr]

Prevention

In selected cases, neurosurgeons may remove part of the skull to alleviate pressure on the brain and prevent further swelling. People who have suffered a spinal injury require immediate treatment to prevent further damage to the spinal cord. [nyp.org]

These are all preventable injuries and can be avoided if people are educated and safety norms are practiced mandatorily. [ncbi.nlm.nih.gov]

The majority of spinal cord injuries are due to preventable causes such as road traffic crashes, falls or violence. [who.int]

How do you Prevent a Spinal Cord Injury? Following are a few measures to be taken to prevent a spinal cord injury. [medindia.net]

Treatment Options for Spinal Trauma Spinal trauma requires immediate treatment, usually at the site of the injury, to prevent additional injury to the spinal cord. [neurosurgeonsofnewjersey.com]

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