Spinal Trauma

Anatomy and Physiology  Vertebral Column  Spinal Cord

Skeletal Injuries  Compression fractures of vertebra  Fractures that produce small fragments of bone  Subluxation: partial dislocation of a vertebra from its normal place in spinal column  Overstretching or tearing of ligaments and muscles

Injuries to the Spine  Varied mechanisms of injury (flexion, extension, rotation, distraction, compression, lateral flexion, combination of forces)  Mostly blunt, some penetrating  Spinal cord injury obviously feared, particularly for cervical spine  Range from unstable injuries to stable

Common causes of spinal cord injury  Motor vehicle accidents.  Acts of violence.  Falls.  Sports and recreation injuries.  Diseases.

Indications for Spinal Immobilization  Altered Level of Consciousness Traumatic Brain Injuries (TBI) Altered Mental Status other than TBI Acute Stress Reaction  Spinal Pain or Tenderness  Neurologic Deficit or Complaint  Anatomic Deformity of the Spine

Signs and Symptoms  The signs and symptoms of a spinal cord injury depend on two factors: 1. The location of the injury. 2. The severity of the injury.  Spinal cord injuries are classified as partial or complete, depending on how much of the cord width is damaged. 1. A partial spinal cord injury, which may also be called an incomplete injury, the spinal cord is able to convey some messages to or from the brain. 2. A complete injury is defined by complete loss of motor function and sensation below the area of injury.

Signs and Symptoms  Paralysis of extremities (The most reliable sign in conscious patient)  Pain with/without movement  Tenderness anywhere along the spine  Impaired breathing  Deformity  Priapism  Posturing  Loss of bowel or bladder control  Nerve impairment to the extremities  Severe spinal shock  Soft tissue injury associated with trauma

Diagnostic Procedures  X-rays.  Computerized tomography (CT) scan: is beginning to become the study of choice in many trauma centers and emergency departments  Magnetic resonance imaging (MRI). Myelography.

Emergency Care Steps  Manual stabilization for head and neck  Assess A, B & C  Assess head & Neck and apply rigid cervical collar  Assess sensory & motor function in all extremities  Apply appropriate spinal immobilization device  Administer Oxygen via NRM if patient has paralysis or weakness.  Reassess motor and sensory in all extremities

Steroid Protocol for Spinal Cord Injury  Solumedrol 30 mg/kg bolus followed by infusion 5.4 mg/kg/hr for next 23 – 48 hours  Controversy exists