Most serious spinal injuries result from motor vehicle accidents, falls, diving into shallow water, and gunshot wounds; less serious injuries result from lifting heavy objects and minor falls. Spinal dysfunction may also result from hyperparathyroidism and neoplastic lesions.

Spinal injury can be complicated by spinal cord damage, resulting in paralysis and even death. The extent of cord damage depends on the level of injury to the spinal column.

The patient’s history may reveal trauma, a neoplastic lesion, an infection that could produce a spinal abscess, or an endocrine disorder. The patient typically complains of muscle spasm and back or neck pain that worsens with movement. In cervical fractures, point tenderness may be present; in dorsal and lumbar fractures, pain may radiate to other body areas such as the legs.

Physical assessment (including a neurologic assessment) helps locate the level of injury and detect any cord damage. General observation of the patient reveals that he limits movement and activities that cause pain. Inspection reveals surface wounds that occurred with the spinal injury.
Palpation can identify pain location and loss of sensation.

If the injury damages the spinal cord, you’ll note clinical effects that range from mild paresthesia to quadriplegia and shock.

Spinal X-rays, myelography, and computed tomography and magnetic resonance imaging scans are used to locate the fracture and site of the compression.

The primary treatment after spinal injury is immediate immobilization to stabilize the spine and prevent cord damage; other treatment is supportive.

Cervical injuries require immobilization, using sandbags on both sides of the patient’s head, a hard cervical collar, or skeletal traction with skull tongs (Crutchfield, Barton, Vinke, Gardner-Wells) or a halo device. (See Skeletal traction devices, page 856.) When a patient shows clinical evidence of a spinal cord injury, high doses of I.V. corticosteroids (methylprednisolone) are started.

Treatment of stable lumbar and dorsal fractures consists of bed rest on a firm surface (such as a bed board), analgesics, and muscle relaxants until the fracture stabilizes (usually in 10 to 12 weeks). Later treatment includes exercises to strengthen the back muscles and a back brace or corset to provide support while walking.

An unstable dorsal or lumbar fracture requires a plaster cast, a turning frame and, in severe fracture, laminectomy and spinal fusion.

When the damage results in compression of the spinal column, neurosurgery may relieve the pressure. If the cause of compression is a neoplastic lesion, chemotherapy and radiation may relieve the compression by shrinking the lesion. Surface wounds that accompany the spinal injury require wound care and tetanus prophylaxis unless the patient has recently been immunized.