Suspected Spinal Injuries

The spine is made up of 33 separate bones, known as vertebrae, extending from the base of the skull to the coccyx (tailbone). Each vertebra surrounds and protects the spinal cord (nerve tissue). 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.

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.

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.

Suspected spinal injuries of the neck, particularly if the victim is unconscious, pose a dilemma for the rescuer because correct principles of airway management often cause some movement of the cervical spine.

Recognition

The most common causes of spinal cord injury are:

  • A motor vehicle, motorcycle 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).

The symptoms and signs of a spinal injury depend on two factors: firstly, the location of the injury and secondly, the extent of the injury – whether there is just bone injury or associated spinal cord injury, and whether the spinal cord injury is partial or complete. It will be difficult to elicit symptoms and signs in victims with an altered conscious state.

Signs of Spinal Injury include:

  • Head or neck in an abnormal position
  • Signs of an associated head injury
  • Altered conscious state.
  • Breathing difficulties
  • Shock
  • Changes in muscle tone
  • Loss of function in limbs
  • Loss of bladder or bowel control and priapism (erection in males).

Symptoms of Spinal Injury include:

  • Pain in the injured region
  • Tingling, numbness in the limbs and area below the injury
  • Weakness or inability to move the limbs (paralysis)
  • Nausea
  • Headache or dizziness
  • Altered or absent skin sensation

Management

The priorities of management of a suspected spinal injury are:

  1. Calling for an ambulance
  2. Management of airway, breathing and circulation.
  3. Spinal care

An awareness of potential spinal injury and careful victim handling, with attention to spinal alignment, is the key to harm minimisation.