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 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.
The most common causes of spinal cord injury are:
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.
The priorities of management of a suspected spinal injury are:
An awareness of potential spinal injury and careful victim handling, with attention to spinal alignment, is the key to harm minimisation.