INJURIES TO THE SPINE
What is the injury?
Most spinal cord injuries are a result from catastrophic falls, car accidents, sports
related, or any kind of physical trauma that can crush or compress the vertebrae.
From these types of injuries, the person or athlete might not even feel the pain due
to an instant paralysis. Or the person or athlete may need to be taken to the
hospital immediately because spinal cord injuries again can crush or compress the
vertebrae which can cause irreversible damage at the cervical level of the spinal
cord, from your neck down to your sacrum.
Most injuries to the spinal cord don't completely sever it. Instead, an injury is more
likely to cause fractures and compression of the vertebrae, which then crush and
destroy the axons, extensions of nerve cells that carry signals up and down the
spinal cord between the brain and the rest of the body. An injury to the spinal cord
can damage a few, many, or almost all of these axons. Some injuries will allow
almost complete recovery. Others will result in complete paralysis.
There are an estimated 10,000 to 12,000 spinal cord injuries every year in the
United States.
38.5 percent of all spinal cord injuries happen during car accidents. Almost a
quarter, 24.5 percent, are the result of injuries relating to violent encounters, often
involving guns and knifes. The rest are due to sporting accidents, falls, and workrelated accidents.
Mechanism of spinal injuries
The commonly observed anatomical displacement in skeletal injuries of the
cervical spine is fracture-dislocation in hyperflexion, and it is caused by
hyperfiexion. Not unnaturally it was supposed that spinal cord damage without
persistent vertebral displacement was caused during acute hyperfiexion ,
involving temporary dislocation, immediately reduced spontaneously
by muscular action.
Fractures resulting from pure vertical compression typically involve the C5--6
region, and they tend to be more stable. Generally, it is necessary for an injury
mechanism to produce a rotational force to result in dislocation. Axial loading has
received the most attention as a mechanism of injury in athletic competitions. Of
209 football-related injuries reported between 1971 and 1975, in 52% of the
patients who suffered from permanent quadriplegia the in jury was attributed to
axial loading. When the head is lowered, the buffering capacity of the cervical soft
tissue diminishes, resulting in an increased amount of compressive forces on the
cervical segments. Furthermore, the cervical flexion obtained by lowering the
head causes disappearance of the normally lordotic cervical spine, resulting in
decreased ability of the cervical spine to absorb and dissipate energy.
Consequently, the strain energy exceeds the absorptive capacity of the vertebral
column.
Views of the spine
First aid and assessment
The outcome of any injury to the spinal cord depends upon the number of
axons that survive: the higher the number of normally functioning axons,
the less the amount of disability. Consequently, the most important
consideration when moving people to a hospital or trauma center is
preventing further injury to the spine and spinal cord.
For immediate first aid of the athlete or person injured, the first thing is to call
an ambulance. While checking or helping the person who has sustained
the injury be sure to:
A. Move the person if the area is crowded or unsafe.
B. Immobilize the head, neck and body on both sides.
C. If there is no sign of breathing, perform CPR .
Once taken to the hospital, the patient should be evaluated by a doctor and it
is also a good thing to get an MRI or CAT scan. After being treated from a
doctor, they may refer you to physical therapy which is treatment for your
injury using physical therapeutic methods.
Treatment & Rehabilitation
Treatment stages include:
*Medications: Methylprednisolone (Medrol) is a treatment option for acute spinal
cord injury. This corticosteroid seems to cause some recovery in people with a
spinal cord injury if given within eight hours of injury.
*Immobilization. You may need traction to stabilize your spine and bring the spine
into proper alignment during healing.
*Surgery. Often, emergency surgery is necessary to remove fragments of bones,
foreign objects, herniated disks or fractured vertebrae that appear to be
compressing the spine. Surgery may also be needed to stabilize the spine to
prevent future pain or deformity.
Rehabilitation:
During the initial stages of rehabilitation, therapists usually emphasize regaining
leg and arm strength, redeveloping fine-motor skills and learning adaptive
techniques to accomplish day-to-day tasks.
Inventive medical devices can help people with a spinal cord injury become more
independent and more mobile. Some apparatuses may also restore function .
Graphics, Facts, and Figures
Since 2000, 77.8% of spinal cord injuries reported to the national database have
occurred among males. Over the history of the database, there has been a slight
trend toward a decreasing percentage of males. Prior to 1980, 81.8% of new spinal
cord injuries occurred among males.
Since 2000, motor vehicle crashes account for 46.9% of reported SCI cases. The
next most common cause of SCI is falls, followed by acts of violence (primarily
gunshot wounds), and recreational sporting activities. The proportion of injuries that
are due to sports has decreased over time while the proportion of injuries due to
falls has increased. Acts of violence caused 13.3% of spinal cord injuries prior to
1980, and peaked between 1990 and 1999 at 24.8% before declining to only 13.7%
since 2000.
The human spinal column provides flexibility for movement, support for weight
bearing and protection of nerve fibers. The spinal column surrounds and protects
the spinal cord, which is the main pathway of communication between the brain and
the rest of the body. The spinal column also protects the nerve roots and part of the
autonomic nervous system.
Sources
Internet sources:
http://www.jbjs.org.uk/cgi/reprint/33-13/4/543.pdf
http://www.medicinenet.com/spinal_cord_injuries-treatments-andrehab./page4.htm
http://www.medindia.net/patients/Firstaid_Spinal_Cord_Injury.htm
http://www.sci-recovery.org/
Pictures are mainly taken off of google images.
Book source:
Sports Medicine Book. Published by Human Kinetics Inc. 2005, 1999.