Trauma

Spinal trauma is often the result of road traffic accidents and in most cases requires emergency assessment, stabilisation and definitive treatment. Trauma to the spine is often accompanied by concurrent injuries to thoracic, abdominal structures as well as other orthopaedic injuries (fractures/luxations).

The spine is a bony column comprising seven cervical, thirteen thoracic and seven lumbar vertebrae. Each vertebrae is connected via an intervertebral disc and two articular facets. This provides a semi flexible protective canal for the spinal cord. Trauma to this bony column can result in serious injury to the spinal cord contained within the central canal. In general clinical signs related to neurological dysfunction, primarily to the legs. Lesions in the cervical spine can result in a tetraparesis (neurological dysfunction to all four legs) whilst injuries occurring further along the spine often present as paraparesis (neurological dysfunction to the hind limbs only).

A diagnosis of spinal trauma can often be achieved with plain radiographic assessment. Radiographs provided a detailed image of the bones of the spinal column and their spatial relationship to each other. Most fractures and luxations can be identified and characterised with standard x-rays. Unfortunately radiography has it’s limitations; it cannot define the spinal cord and only provides a two dimension picture of a complex 3D structure.

CT provides cross sectional imaging of the spine, producing a highly detailed sequence of images and 3D models that aids the surgeon in making a diagnosis, prognosis and treatment plan. CT myelography outlines the spinal cord and allows assessment of any spinal cord compression, but is limited for assessing soft tissue injury to the cord.

MRI is the gold standard for evaluating the intramedullary structure of the spinal cord, and can therefore be used to determine the degree of damage that may be present. It is a poor modality for imaging the bones of the spine and is considered complementary to CT.

Spinal trauma cases are assessed on an individual basis and a treatment plan will be tailored for each patient. Not all spinal trauma patients require surgery, especially of they are ambulatory, injury to the spinal column is considered stable and there is minimal compression of the spinal cord. Patients which are non ambulatory, have unstable injuries with compression or the potential to compress the cord are considered surgical emergencies. Spinal stabilisation is often achieved with plates, screws, rods and bone cement which act as an internal brace supporting the bony column during the healing process. Prognosis is dependent on the severity of the neurological dysfunction at time of presentation, with many patients requiring prolong hospitalisation and spinal nursing.