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:
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
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.
Depending on the location and severity of the injury, the damage may cause:
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.
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.
There are multiple causes of traumatic spine injuries; these include:
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:
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.
Imaging tests commonly used in diagnosing traumatic spine injury include:
To check for broken bones or dislocations. Dislocations refer to bones that are knocked out of their original location.
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.
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:
Simple Xrays but it can exclude the instability of the affected area of the spine for surgical intervention.
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.
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.
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.
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.
Depending on the severity of the injury, decompression surgery may be necessary:
Other possible treatments include:
Specific treatment would depend on a few factors:
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.
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.
Many neurological conditions may require urgent attention. If you require immediate care, please contact us.
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We provide quality specialised care for neuro and spine conditions.
For enquiries, leave a message and our friendly team will get in touch with you.
Monday – Friday: 9:00AM – 5:00PM
Saturday: 9:00AM – 12:30PM
Sunday & Public Holiday: Closed
We provide quality specialised care for neuro and spine conditions.
For enquiries, leave a message and our friendly team will get in
touch with you.
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