Traumatic Spine Injuries

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What is a Traumatic Spine Injury?

A traumatic spine injury is any traumatic injury that damages the spinal cord, leading to a temporary or permanent change in neurological function, including paralysis. These injuries have a significant impact on the physical, mental and social well-being of the patients.

The spine serves as the primary axial backbone that protects the spinal cord and nerve roots. Any injury or impact in the spine has the potential to cause damage to both the bony spine and the spinal cord. The type of injury and the severity of the initial impact on the spine will determine the extent of spinal cord damage and skeletal injuries.

The main spine bone is connected to both the upper and lower limbs for mobility, along with a series of ribs for respiratory movement. Hence, a traumatic spine injury can result in the loss of many vital bodily functions such as sense and movement, respiration and breathing, blood circulation, blood pressure, bowel movement, as well as bladder control. Therefore, the extent of damage can be either neurological or bony structure-related with instability.

There are two types of neurological damage in traumatic spine injuries related to the spinal cord:

Complete

A complete loss of function (paralysis) on both sides of the body below the level of injury. It can be further classified into two sub-types:

• Quadriplegia: Paralysis of all four limbs
• Paraplegia: Paralysis in the lower half of the body

Incomplete

Following the injury, some function remains on one or both sides of the body as there are still certain pathways that allow communication between the brain and body.

Structural damage to the spinal axial bone, such as cracks in the vertebral body or fractures in facet joints with ligament injuries, can result in either a stable or unstable spine injury. Unstable spine injuries are more dangerous for the patient and put them at risk of neurological deficits. Therefore, any suspected spine injury patient should be carefully managed, and the patient should be transported to the nearest accident and emergency department by trained paramedics.

What are the Symptoms of a Traumatic Spine Injury?

Depending on the location and severity of the injury, the damage may cause:

Sudden loss of sensation or movement on either side of the body or limb
Loss of bladder, bowel, and sexual functions
Abnormal breathing, low blood pressure, and heart rate
Decreased muscle movement and reflexes
Unusual lumps and uneven gaps along the spine
Severe, intractable pain or pressure along the spine (in the neck or along the back)

The symptoms people experience can vary depending on the type of injury, the level of the affected spinal cord and the extent of damage in the nerve fibres and tracts in the spinal cord.

When Should You See a Doctor?

If you experience significant trauma around your head or neck area, it is advised to visit the emergency room immediately to seek a medical evaluation for traumatic spinal injuries. It is always safer to presume that there is an injury until proven otherwise.

It is important to note that some traumatic spine injuries do not present immediate symptoms, especially those involving stable spines. The loss of sensation, progressive weakness, and other symptoms may occur gradually. If not attended to or treated by medical personnel, this could worsen and develop into more severe neurological deficits. This, in turn, will influence the anticipated extent of recovery.

The spinal cord plays a critical role in allowing us to perform our basic functions. If you suspect any trauma around your spinal cord, it is best to obtain a definitive diagnosis.

How are Traumatic Spine Injuries Caused?

There are multiple causes of traumatic spine injuries, including:

Falls
Motor vehicle-related accidents
Sports injuries (diving, trampoline, etc.)
Attacks by a weapon (gunshot, stab wounds, etc.)
Infections that form an abscess on the spinal cord
A complication of other diseases (cancer, arthritis, osteoporosis, etc.)
Surgical complications (rarely)

What Complications Can Arise from an Untreated Spine Injury?

If left untreated, the injury could progress in severity with further complications. As the spinal cord plays a vital role in controlling your nerves and muscles, an untreated spine injury may lead to:

Changes in bladder control, which leads to an increased risk of:
- Urinary tract infections
- Kidney and bladder stones
Changes in bowel control
Pressure injuries (due to loss of skin sensations); more susceptible to pressure sores
Abnormal circulatory control, leading to:
- Low blood pressure
- Swelling in your extremities
- Increased risk of blood clots
Difficulty breathing; higher risk of pneumonia and other lung conditions
Increased risk of osteoporosis and fractures below the level of the injury
Issues with muscle tone
- Spasticity: uncontrolled tightening of the muscles
- Flaccidity: soft and limp muscles
Weight loss and muscle atrophy (weakness)
Impacted sexual health
- Male: changes in erection and ejaculation
- Females: changes in lubrication
Constant muscle or joint pain
Increased risk of depression

What Can I Expect During My First Consultation?

When you are brought to the emergency room with signs of traumatic spine injury, the first thing your doctor would do is to ensure that the injury does not affect your breathing and heart rate. Following that, the doctor would assess how well your spinal cord and nerve roots are working by performing a thorough neurological examination to check:

Ability to move parts of your body (motor)

Ability to feel touch and sensations (sensory)

Ability to balance the body

Ability to control your bladder and bowel sphincters

Once you are stabilised, further tests will be carried out to evaluate the location and extent of your injury.

Imaging tests commonly used in diagnosing traumatic spine injury include:

X-Ray

It is used to check for broken bones or dislocations. Dislocations refer to bones that are knocked out of their original position.

CT (Computed Tomography)

A non-invasive X-ray imaging test that provides detailed 3-dimensional images of the spine vertebral bodies and their relation to the spinal cord and nerve roots, as well as the alignment of the spine. It is used to identify the type of fracture in the broken bones as well as the presence of blood clots or blood vessel damage with contrast.

MRI (Magnetic Resonance Imaging)

A non-invasive test that utilises a magnetic field to visualise the detailed anatomy and underlying pathology of the spinal cord, nerve roots, ligaments and soft tissues along the spine.

Depending on your condition, you might also be sent for:

Dynamic and Static X-Rays of Your Whole Spine

Simple X-rays, but they can exclude the instability of the affected area of the spine for surgical intervention.

Sensory and Motor Electrical Stimulation Test (NCS and EMG)

A test to evaluate the electrical activity in muscles and nerve cells to detect co-existing peripheral nerve injury. These tests are only performed once the patient’s clinical condition is stable enough to go for the test.

CSF (Cerebrospinal Fluid) Studies

The CSF will be collected through a procedure known as a spinal tap. White blood cell count, red blood cell count, and other biomarkers will be analysed to diagnose infections and internal bleeding, which could be life-threatening. Moreover, recent research also suggests that certain biomarkers in the CSF can be used to determine the patient’s prognosis of recovery.

CT Angiography

This is used when a fracture passes through the cervical bone, thus suggesting a possibility of damage to the vertebral artery and both carotid arteries as well as the Circle of Willis.

How are Traumatic Spine Injuries Treated?

The first line of treatment for a traumatic spine injury involves spinal nursing, which entails immobilising the fracture with the unstable spine to prevent further neurological damage to the spinal cord and nerve roots. Immobilisation stabilises your spine using stiff neck collars or spinal nursing with skeletal traction and other external braces, such as a Halo vest.

However, in more severe cases, immediate spinal cord injury treatment may involve decompression and instrumentation via either open or minimally invasive surgery. This addresses spinal cord damage from broken bones, removes blood clots, and repairs damaged tissue.

After the surgery, it is critical to optimise blood flow to the spine while closely monitoring and evaluating neurologic function. Proper analgesics and corticosteroid injections help reduce the swelling in the spinal cord and relieve pain.

Minimally Invasive Spine Surgery

Minimally invasive spine surgery, or MISS, is a surgical procedure that uses specialised instruments and tiny incisions. Its main purpose is to treat spinal disorders while minimising the impact on nearby muscles and tissues. This technique includes a variety of procedures to treat diverse spinal conditions, such as endoscopic spine surgery and other treatments performed with needles or scopes through incisions that are usually less than 1 cm in size. With the use of smaller openings and specialised instruments, minimally invasive spine surgeries often accomplish effective results while minimising damage to muscles, spinous processes, ligaments, and tissues.

In minimally invasive surgery, the surgeon heavily relies on image guidance technology such as pre-and intraoperative 3D imaging, CAT scans, fluoroscopy, and intraoperative navigation. First, the procedure begins with creating small incisions directly over the pathological area. Then, instead of dissecting them like in open surgery, special retractors are utilised to dilate soft tissues and move muscles out of the way. In the end, sutures are used to close the tiny incisions made during minimally invasive spine surgeries. The reduced incision size also provides benefits such as faster recovery, less postoperative discomfort, and, in some cases, outpatient ambulatory care.

Depending on the severity of the injury, decompression surgery may be required:

Optimally done within 24 to 48 hours from the injury, it aims to remove any compression elements such as blood clots or fracture segments of bone over the spinal cord and nerve roots.
It may include at least 1 of these procedures:
- Laminectomy – Removing a section of the bone from 1 of the spinal bones
- Discectomy – Removing a section of a damaged disc
- Spinal Fusion – Joining 2 or more spinal bones to stabilise and strengthen the spine
Usually, it is only performed in patients with incomplete cord injuries, as patients may have significant neurologic improvements following the surgery.
It is not commonly used for complete injuries as it is very unlikely for neurologic functions to return in those cases.

Other possible treatments include:

Internal Fixation and Instrumentation – Placing metal rods, screws, and/or hooks to stabilise and protect the spinal cord from additional injuries.
Bone Grafting for Fusion – Taking a bone graft from the back of the pelvis or rib to be placed on the injured area. Over the next 3 to 6 months, this bone graft will fuse into the spinal bones, thus further stabilising the spine.

Specific treatment would depend on a few factors:

Age and medical history
Extent of injury
Type of injury
Patient’s response to the initial treatment
Expected course of the injury and prognosis for recovery

Summary

A traumatic spine injury can affect a person’s basic function, directly impacting their quality of life and socioeconomic opportunities. If you have suffered head or neck trauma or are experiencing any of the symptoms listed above, it would be wise to seek medical attention from a neurosurgeon in Singapore.

Dr Sein Lwin is an experienced Senior Consultant Neuro & Spine Surgeon and the Neurosurgical Director at the Advanced Brain and Spine Surgical Centre.

He is highly experienced in spine surgery and in minimally invasive approaches for spinal cord tumours and degenerative spine surgery. His specialised interests lie in endoscopic endonasal and open skull base surgery, pituitary tumours, vascular surgery, cranial nerve disorders and peripheral nerve conditions.

Urgent Care

Many neurological conditions may require urgent attention. If you require immediate care, please contact us.