Assessment of Spinal Injury
Stephen Schutts, Master Sergeant, WA ANG
National Registry Emergency Medical Technician - Paramedic
1
Objectives
Identify the anatomical levels of the
spine.
 Understand the function of the spinal
cord/column.
 View Types and Mechanisms of injury
that can cause spine injury.
 Discuss the difference between Spinal
Column Injury vs Spinal Cord Injury.

Objectives
Overview of Spinal Regions and
Injuries
 Step by step view of the EMS Spinal
Immobilization Assessment Protocol
 Discuss Common
Treatment/Management Mistakes

Introduction
Spinal injuries are devastating
 Improper management can have
horrible and permanent results
 Appropriate use of spinal
immobilization can mean the difference
between a patient who fully recovers
and one who must spent the rest of
his/her life paralyzed

Mechanism based assessment
(the current method)



Low-speed fender
bender
An elderly man trips
over a lamp cord and
falls
When in doubt back
board ‘em
Are all 8 patients assumed
to have spinal injuries?
Does this man have a
spinal injury? Do all
such falls cause spinal
injuries?
Not necessarily, apply
EMS Spinal
Immobilization.
Anatomy & PhysiologyGeneral Structure & Function
Spinal Column
 Made up of 26
vertebrae stacked on
top of one another
 Divided into 5 areas;
cervical, thoracic,
lumbar, sacral, and
coccyx
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Anatomy & Physiology“Long Bone”
Think of the Spinal
Column as on “Long
Bone” with “Joints”
at each end
– The Cervical spine
makes up one “joint”
– The Hip makes up
the other
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Anatomy & PhysiologyCervical Spine (7)




“Joint” at the superior
end of the spinal “Long
Bone”
Very flexible
– Allows flexion,
extension, and rotation of
the head
The head acts as a weighted
lever during acceleration/
deceleration
Common site of spinal
injuries
C-1 “Atlas”
C-2 “Axis”
•C-1 supports the full weight of the head
•C-1 and C-2 allow head rotation and fine flexion and
extension
Anatomy & PhysiologyThoracic Spine (12)

Much less flexible than C-Spine
– Stabilized by rib cage (especially down to
T-10)

Spinal canal narrow through T-Spine
– Spinal cord tightly fitted into narrow space
– Spinal cord ends about T-12 or L-1
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Anatomy & PhysiologyLumbosacral Spine
5 Lumbar vertebrae plus sacrum and
coccyx
 More flexible than T-spine
 More room in spinal canal
 Spinal cord ends about T-12 or L-1

– flexible nerve roots (Cauda equina) flow
through LS spine
Anatomy & PhysiologySpinal Cord
Bundles of nerve fibers originating in
the brain
 Bundles or tracts travel in right and left
pairs
 Spinal Tract pairs crossover midline at
various specific levels

– always in specific anatomical areas
– understanding of the structure of these
tracts helps in assessing spinal cord injuries
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Mechanism of Injury
Physical manner and forces involved in
producing injuries or potential injuries
 Valuable tool in determining if the a
particular set of circumstances could
have caused a spinal injury
 Mechanisms likely to produce spinal
injuries occur in MVAs, falls, violence,
and sports (including diving accidents)

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Hyperflexion
Hyperextension
Hyperotation
Axial Loading
Axial Distraction
Sudden/Extreme Lateral
Bending
Excessive/abnormal lateral movement
of the spine
 Can affect any portion of the spine
 Example: T-bone MVAs

Spinal Column Injury


Bony spinal injuries may or may not be
associated with spinal cord injury
These bony injuries include:
– Compression fractures of the vertebrae
– Comminuted fractures of the vertebrae
– Subluxation (partial dislocation) of the vertebrae

Other injuries may include:
– Sprains- over-stretching or tearing of ligaments
– Strains- over-stretching or tearing of the muscles
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Spinal Cord Injury



Cutting, compression, or stretching of the
spinal cord
Causing loss of distal function, sensation, or
motion
Caused by:
– Unstable or sharp bony fragments pushing on the
cord, or
– Pressure from bone fragments or swelling that
interrupts the blood supply to the cord causing
ischemia
Primary Spinal Cord Injury
Immediate and irreversible loss of
sensation and motion
 Cutting, compression, or stretching of
the spinal cord
 Occurs at the time of impact/injury

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Secondary Spinal Cord
Injury
Injury Delayed
 Occurs later due to swelling, ischemia,
or movement of sharp or unstable bone
fragments
 May be avoided if spine immobilized
during extrication, packaging,
treatment, and transport

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Incomplete Spinal Cord
Injury
Complete injury to specific spinal tracts
with reduced function distally
 Other tracts continue to function
normally with distal function intact

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Spinal Region Overview
Cervical Spine Injuries
 Thoracic Spine Injuries
 Lumbosacral Spine Injuries
 Spinal Injury Summary

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Cervical Spine Injuries
C-spine very flexible
 Most frequently injured area of spine
 Most injuries at C-5/C-6 level

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Thoracic Spine Injuries
T-spine less flexible
 Narrow spinal canal
 Cord injury occurs with minimal
displacement
 Common mechanisms
 Any cord damage usually complete at
this level
 Most T-spine injuries occur at T-9/T-10

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Lumbosacral Spine Injuries
LS spine flexible nerve roots in roomy
spinal canal
 May have bony injury w/o cord or
nerve root damage
 Secondary injury still possible
 Neurological injury rare w/ isolated
sacral injuries

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Assessment Overview
Decision to apply spinal immobilization
in past based was solely on mechanism
of injury
 Utilize EMS Spinal Immobilization
Algorithm to determine when spinal
immobilization is NOT needed

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Spinal Immobilization Algorithm
Patient Mentation:
Decreased Level of Consciousness?
No
Yes ----------------------------Immobilize
ETOH/Drug Impairment?
No
Yes ----------------------------Immobilize
Subjective Assessment:
Cervical/Thoracic/Lumbar Spinal pain?
No
Yes ----------------------------Immobilize
Numbness/Tingling/Burning/Weakness?
No
Yes -----------------------------Immobilize
Objective Assessment:
Cervical/Thoracic/Lumbar Deformity or Tenderness?
No
Yes -----------------------------Immobilize
Other Severe Injury?
No
Yes -----------------------------Immobilize
Other Severe Injury?
No
Yes -----------------------------Immobilize
Pain w/Cervical Range of Motion?
No
Yes -----------------------------Immobilize
MAY TREAT/TRANSPORT WITHOUT SPINAL PRECAUTIONS
Principles of Treatment
Protect spinal cord from secondary
injury
 We have little or no effect on primary
injury
 Focus on prevention of secondary
injury

Complete Spinal
Immobilization
Must act as if whole spine unstable
 Immobilize entire spine
 To do this we must immobilize the
head, neck, shoulders/chest, and pelvis
/hips

Common
Treatment/Management
Mistakes






Improperly sized C-Collar
Spine not supported due to improper positioning on
backboard
Inadequate strapping allows excessive movement
Movement possible due to little or no padding to
shim the body
C-spine movement by inadequate or improperly
applied head immobilization device
C-spine hyperextension due to improperly applied
C-collar or head immobilization device
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Common
Treatment/Management
Mistakes (cont.)


Readjusting torso straps after immobilization of the
head, causing misalignment of the spine
Securing head to backboard prior to securing
shoulders, torso, hips, and legs
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Any Questions???