Spinal Trauma: Beyond Spinal Cord Injury

When most people think of spinal trauma, spinal cord injury comes to mind. But there are other types of spinal trauma that affect your spinal column’s vertebrae, intervertebral discs and nerves. Here, you’ll find an overview of spinal trauma, including treatments that help preserve your physical and emotional health after serious spine injury.

What Can Cause Spinal Trauma?

As the name suggests, spinal trauma occurs after a traumatic event. Car accidents are a common cause of spinal injury, as are sports injuries and falls. Violent acts from stabbing, a gunshot wound, or domestic violence may also cause traumatic spinal injury.

6 Types of Spinal Trauma

Spinal cord injury is perhaps the most well-known type of traumatic event affecting the spine—but it’s not the only one. Below are other spinal injuries that may be caused by trauma:

• Spinal fracture: Trauma can cause several types of spinal fractures—that is, a break or compression of a bone in your back or neck. Severe cases of vertebral injury can damage your spinal cord, which requires urgent surgical treatment to help prevent permanent nerve damage.

• Pelvic fracture: The pelvis sits at the base of your spine, and fractures of this kind are most often caused by high-impact car accidents or falls. But if you have weakened bones from osteoporosis, even a seemingly small fall can cause a pelvic fracture.

• Herniated disc: While degenerative changes often related to aging and wear and tear on the spine can contribute to or cause disc herniation, traumatic forces that may be sudden can trigger a disc to bulge or rupture. If a herniated disc presses on the spinal cord and/or nerve roots, the outcome often produces neurological dysfunction such as myelopathy (neck) or radiculopathy (neck, low back) that may require surgical intervention.

• Whiplash: Whiplash is a neck injury that most people associate with car accidents, but it can also occur from sports injuries, falls, or being shaken. What makes whiplash traumatic is it’s a hyperflexion/ hyperextension type of injury. This means the head and neck is whipped suddenly and repeatedly forward and backward. Non-surgical treatments, like non-steroidal anti-inflammatory medication, and ice and heat, are usually enough to manage whiplash—surgery is rarely needed. Sometimes a flexible cervical collar is recommended for short-term use to reduce the weight of the skull while supporting the neck.

• Cauda equina syndrome (CES): This rare but serious disorder affects the bundle of nerves called the cauda equina located in the low back (lumbar spine). A vehicle collision, violent act (eg, gunshot wound), or fall can cause CES to develop from an injury-related herniated disc or spinal fracture. The caudal nerves supply sensation and function to the bowel, bladder and legs. CES requires urgent surgical intervention to help prevent permanent nerve damage that may cause paralysis.

• Retrolisthesis: Spinal injury, such as fracture can cause retrolisthesis, a rare disorder wherein a vertebral body slips backward over the vertebra beneath it. Retrolisthesis is the opposite of spondylolisthesis, a more common disorder wherein a vertebral body slides forward over the vertebra below. The abnormal movement of the vertebral body is called displacement. Similar to spondylolisthesis, the severity of a retrolisthesis is graded by its degree of displacement. Spine surgery may be necessary if displacement is severe potentially causing spinal instability and/or neurological dysfunction.

How Does a Doctor Diagnose Spinal Trauma?

Spinal damage can be caused by trauma that is seemingly unrelated to the spine. For example, a head injury may cause spinal trauma. That’s why your doctor will perform tests to determine whether your spine was impacted, even if you think your back and neck were unaffected by the event.

After a physical examination and neurological evaluation (which will test your reflexes and feeling in your arms and legs), your doctor may order x-rays and/or imaging scans to confirm suspected areas of spinal damage. The 3 imaging tests most often used to diagnose spinal trauma are x-rays, computed tomography (CT) scans, and magnetic resonance imaging (MRI).

X‑rays are considered a first-line imaging test, which means your doctor may order an x-ray first to see any obvious bone abnormalities—like spinal fractures. But x-rays don’t tell the full story of spinal trauma, as they can’t illuminate soft tissues like spinal nerves. That’s why your doctor may also order a CT scan and/or MRI.

While MRI provides the most detailed and accurate picture of spinal injury (it clearly shows soft tissue abnormalities, like disc herniation), it requires more time than a CT scan. Since time is of the essence when treating spinal trauma—addressing nerve damage and spinal instability quickly may help preserve function—CT scan may be the imaging tool your doctor relies on to accurately diagnose spinal trauma.

If you have sustained spinal trauma, your doctor may classify the type and severity of your injury with a tool called the American Spinal Injury Association (ASIA) Impairment Scale. This scale helps “grade” your injury from A to E, with A being the most severe injury and E the least.

Giving your spinal injury a specific grade aligns all the medical professionals involved in your care, and it helps you better understand the extent of your injury.

Surgery to Treat Spinal Trauma

While some forms of spinal trauma may not require surgery, injuries that threaten the stability of your spine and/or compress your spinal nerves may warrant surgical intervention. Timing of treatment matters greatly after spinal trauma, as it can help preserve nerve function. The longer nerve damage goes untreated, the more likely it may become permanent.

Surgery for spinal trauma varies based on the type of injury you sustain. But overall, the treatment goals for spinal trauma focus on 2 key components:

1. Stabilize the spine
2. Preserve the health of your spinal cord and spinal nerves

To relieve compressed nerves, your spine surgeon may perform a decompression surgical procedure. Examples of decompression surgeries include laminotomy and laminectomy. A common decompression procedure for cervical (neck) spinal trauma is a corpectomy, which involves removing 2 intervertebral discs and the vertebral body between them.

To re-stabilize your spine, your doctor will perform a spinal fusion with or without instrumentation. Depending on the location and nature of your spinal injury, your surgeon may use an anterior (from the front of your body) or posterior (from the back of your body) approach—or a combination of the 2—when performing the decompression and fusion.

Life After Spinal Trauma

Readjusting to life after spinal injury can be challenging, so your medical team may take a multi-disciplinary approach to your care—that is, using several therapies to comprehensively address various types of pain (mental, emotional, and physical).

Your medical team may prescribe different medications to help address everything from pain to spasticity (a condition causing stiff, rigid muscles that limit movement).

A rehabilitation program is also an essential component to spinal trauma recovery. Several clinicians may be involved in your rehabilitation, such as doctors, nurses, physical therapists, occupational therapists, psychologists, speech therapists, counselors, and recreational therapists. These professionals work together and with you to restore as much of your physical function as possible while addressing the mental and emotional hurdles that often accompany the aftermath of spinal trauma.

Physical therapy helps teach you exercises and stretches to improve muscle strength and flexibility. It may also promote your independence and mobility by helping you learn how to use assistive devices (eg, wheelchair, walker, cane). An occupational therapist and/or vocational therapist may help you improve fine motor skills and cognitive function.

Addressing the physical side of spinal trauma is only one piece of the rehabilitation puzzle—the emotional and mental side is just as vital to a good quality of life. Counselors and psychologists can help you express, manage, and understand your concerns, fears, and emotions from spinal trauma. Family and friends may be included in your therapy to help learn how they can best support as you recover or potentially readjust to a new lifestyle. By relying on your medical team and personal support system, you can overcome the challenges of recovery and thrive after spinal trauma.

SOURCE: https://www.spineuniverse.com/conditions/spinal-disorders/spinal-trauma-beyond-spinal-cord-injury