Traumatic Spine Injuries

Has this article been insightful? Share it!

What is a traumatic spine injury?

As the spine is the main axial backbone and protects the spinal cord and nerve roots, any injury and impact in the spine can cause damage to the bony spine as well as the spinal cord. The damage to the spinal cord and skeletal injuries will depend on the type of injury and the extent of initial impact to the spine.

The main spine bone is a key axial backbone attached to both the upper and lower limbs for mobility, along with a series of ribs for respiratory movement. As such, a traumatic spine injury may cause the loss of many essential bodily functions – not only sense and movement but also respiration and breathing, blood circulation and blood pressure, bowel movement and bladder control. Therefore, the extent of damage can be either neurological damage or bony structure damage with instability.

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

Complete

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

• Quadriplegia: paralysis of all four limbs
Paraplegia: paralysis of 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 ligaments injuries – can either be 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 after injury
  • Loss of bladder, bowel, and sexual function
  • 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 may differ 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, you should visit the emergency room immediately to get a medical evaluation for traumatic spinal injuries. It is always safest to assume that there is an injury before proven otherwise.

It is important to note that some traumatic spine injuries, particularly with stable spines, do not come with immediate symptoms. The loss of sensation, progressive weakness and other symptoms may be gradual. If left untreated or unattended to by medical professionals, this could worsen and progress into more severe neurological deficits. This, in turn, will impact the possible extent of expected recovery.

As mentioned previously, the spinal cord plays a critical role in allowing us to perform our basic functions. If you suspect any trauma around your spinal cord, your best bet is to get a definite diagnosis.

How are traumatic spine injuries caused?

There are multiple causes of traumatic spine injuries; these include:

  • Falls
  • Motor vehicle-related accidents
  • Sports injuries (diving, trampoline, etc.)
  • Attacked 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 may progress in severity with further complications. As the spinal cord plays a vital role in controlling your nerves and muscles, 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, increased 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 someone is brought to the emergency room with signs of traumatic spine injury, the first thing I would do is to ensure that the injury does not affect your breathing and heart rate. Following that, I would assess how well your spinal cord and nerve roots are working, which is done through 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.

What can I expect during my first consultation?

Imaging tests commonly used in diagnosing traumatic spine injury include:

X-ray

To check for broken bones or dislocations. Dislocations refer to bones that are knocked out of their original location.

CT (Computed Tomography)

A non-invasive X-ray imaging test that provides detailed 3-dimensional images of the spine vertebral bodies and relation to the spinal cord and nerve roots as well as for 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 Xrays but it 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 check for co-existing peripheral nerve injury. These tests are only performed after 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 called 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. Above that, 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 if 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?

Endoscopic Spine Surgery

The first line of treatment involves spinal nursing, which is the immobilisation of the fracture with the unstable spine to prevent further neurological injury in the spinal cord and nerve roots. Immobilisation stabilises your spine using stiff neck collars or spinal nursing with skeletal traction and other external braces like a Halo vest.

However, the immediate treatment for a traumatic spine injury is likely to be decompression and instrumentation via surgical intervention for more severe cases. This addresses spinal cord damage from broken bones, removes blood clots, and repairs damaged tissue.

After the surgery, it is important to optimise blood flow to the spine and closely monitor and assess neurologic function. Appropriate analgesics and corticosteroid injections help decrease the swelling in the spinal cord and alleviate pain.

Traumatic brain injuries icon

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

  • Optimally done within 24 to 48 hours from the injury, aimed to remove any compression elements like 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 only performed in patients with incomplete cord injuries as patients may have significant neurologic improvements following the surgery.
  • 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 initial treatment
  • Expected course of the injury and prognosis for recovery

Summary

A traumatic spine injury may impact a person’s basic function and in extension to that, their quality of life and socioeconomic opportunities. It is always recommended to visit a doctor if you experienced trauma to the head or neck, or experiencing some of the symptoms mentioned above. Early diagnosis and treatment will greatly increase your chances of recovery.

Dr Sein Lwin Author

Dr Sein Lwin

Senior Consultant Neuro & Spine Surgeon
MBBS, MSc Surgery, MRCS (Edin), MMed. Sc (Gen Surg) (S'pore), FRCS. Surgical Neurology (UK)

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.