Spine and Spinal Cord Injury

Spinal injury may be Bony spine injury or Spinal cord injury or a combination of both

Causes of Spinal Injury

• Motor vehicle accidents
• Fall from height
• Sports injury
• Assault
• Trivial fall in elderly

More common in young adults and in males

Spine is divided into following segments

• Cervical
• Thoracic
• Lumbar
• Sacro-coccygeal

Signs and symptoms depend on the level and severity of injury

• Upper and lower limb weakness
• Loss of sensation
• Loss of bladder and bowel control
• Respiratory failure in high cervical cord injury

In whom should we suspect spine injury

• Every patient with a head injury and every unconscious patient
• Every patient with multiple trauma
• Every motor-vehicle accident victim
• Every victim of a sports or recreational accident
• Every severely injured worker
• Every victim of a fall at home
• Every SCI has an unstable spinal column and any movement of the spinal column after trauma will cause further damage to the spinal cord

Mechanism of Injury

How should we shift a suspected case of spine injury

• Pt should be shifted ind neutral position on a spine board or stretcher after putting cervical collar or spinal brace and securing the patient to the spine board or stretcher with straps.
• Avoid spine movements like twisting, turning etc
• Be alert to associated injuries especially in polytrauma
• Shift patient to tertiary care hospital

Investigations required in Spine injury patients

• MRI Scan
• CT Scan
• X-Rays

Management of Acute Spinal Cord Injury

• Medical Management
• Surgical Management

Medical management

• Steroids (in select patients)
• Maintenance of BP
• Antibiotics
• Physiotherapy
• Nursing care
• Prevention of bed sores

Surgical Management

• Bony stabilization using implants like screws, rods and cages with bone graft

Recovery after Spine injury

• Depends on severity of spinal cord injury
• Complete injuries have poor neurological outcomes
• Many patients can make a meaningful recovery
• May require long term rehabilitaion and nursing care
• May require long term/lifelong ventilator support in high cervical cord injuriy
• Loss of bladder and bowel control may be permanent

Death in Spinal Cord injury patients

• • Respiratory failure in cervical and cranio vertebral junction injuries
  • Chest infections
  • Hypotension and cardiovascular complications
  • Urosepsis and renal failure
  • Associated injuries

Take home message

• • • Prevention is better
    • There is no miracle medicine to heal and repair the spinal cord
    • Surgery for spine injury is for bony stabilisation and relieving the pressure on the cord
    • Spinal cord cannot be repaired by surgery
    • Spinal cord transplant is not possible
    • Stem cell therapy is unlikely to help