What is a spinal injury?

The possibility of spinal injury must be considered in the overall management of all trauma victims.  The risk of worsening the spinal injury in the prehospital period is probably less than previously thought, yet to minimise the extent of the secondary injury, caution must be taken when moving a victim with a suspected spinal injury.

The most common causes of spinal cord injury are:

• a motor vehicle, motor cycle or bicycle incident as an occupant, rider, or pedestrian
• an industrial accident (i.e. workplace)
• a dive or jump into shallow water or water with obstacles or being “dumped” in the surf
• a sporting accident (e.g. rugby, falling from a horse)
• a fall from greater than a standing height (e.g. ladder, roof)
• falls in the elderly population
• a significant blow to the head
• a severe penetrating wound (e.g. gunshot).

Spinal injuries can occur in the following regions of the spine:

• the neck (cervical spine)
• the back of the chest (thoracic spine)
• the lower back (lumbar spine).

The cervical spine is most vulnerable to injury, which must be suspected in any victim with injuries above the shoulders. More than half of spinal injuries occur in the cervical region.

Spinal cord injury

Fractures or dislocations to the vertebral bones may result in injury to the spinal cord. The direct mechanical injury from the traumatic impact can compress or sever the nerve tissue. This is followed by secondary injury caused by ongoing bleeding into the spinal cord as well as continued swelling at the injured site and surrounding area.

There are two types of injury which are known as complete and incomplete.

Complete injury
The spinal cord is damaged across the whole of its width so that there is no function below the level of injury.

Incomplete injury
The injury does not spread across the whole of the spinal cord; some areas away from the injury remain intact or at least intact enough to retain some function. People with incomplete injuries have some sensation and/or movement control below the level of injury.