Anatomy and Physiology
Compression fractures of vertebra
Fractures that produce small fragments of
Subluxation: partial dislocation of a vertebra
from its normal place in spinal column
Overstretching or tearing of ligaments and
Injuries to the Spine
Varied mechanisms of injury (flexion,
extension, rotation, distraction, compression,
lateral flexion, combination of forces)
Mostly blunt, some penetrating
Spinal cord injury obviously feared,
particularly for cervical spine
Range from unstable injuries to stable
Common causes of spinal cord injury
Motor vehicle accidents.
Acts of violence.
Sports and recreation injuries.
Indications for Spinal Immobilization
Altered Level of Consciousness
Traumatic Brain Injuries (TBI)
Altered Mental Status other than TBI
Acute Stress Reaction
Spinal Pain or Tenderness
Neurologic Deficit or Complaint
Anatomic Deformity of the Spine
Signs and Symptoms
The signs and symptoms of a spinal cord injury depend
on two factors:
1. The location of the injury.
2. The severity of the injury.
Spinal cord injuries are classified as partial or
complete, depending on how much of the cord width is
1. A partial spinal cord injury, which may also be called an
incomplete injury, the spinal cord is able to convey some
messages to or from the brain.
2. A complete injury is defined by complete loss of motor
function and sensation below the area of injury.
Signs and Symptoms
Paralysis of extremities Priapism
(The most reliable sign in Posturing
conscious patient) Loss of bowel or bladder
Pain with/without control
movement Nerve impairment to the
Tenderness anywhere extremities
along the spine Severe spinal shock
Impaired breathing Soft tissue injury
Deformity associated with trauma
Computerized tomography (CT) scan: is
beginning to become the study of choice in
many trauma centers and emergency
Magnetic resonance imaging (MRI).
Emergency Care Steps
Manual stabilization for head and neck
Assess A, B & C
Assess head & Neck and apply rigid cervical collar
Assess sensory & motor function in all extremities
Apply appropriate spinal immobilization device
Administer Oxygen via NRM if patient has paralysis
Reassess motor and sensory in all extremities
Steroid Protocol for Spinal Cord Injury
Solumedrol 30 mg/kg bolus followed by
infusion 5.4 mg/kg/hr for next 23 – 48 hours