There is a high incidence of concomitant adjacent spinal injuries which warrant a strict precautions for the entire spine when encountered at the injury site.
As a protocol a cervical collar should be applied and patient should be put on a flat spine board should be standard protocol during in-field evaluation and transport.
Spinal shock may be recognized by hypotension [decrease in blood pressure] and bradycardia [decrease in heart rate]. An absent bulbocavernosus reflex in a trauma victim can indicate spinal shock. The prognosis for the potential of neurologic recovery cannot be determined until spinal shock has resolved.
Spinal shock is generally considered to have ended either after 48 hours from injury or once the bulbocavernosus reflex returns.
It is critical to distinguish neurogenic shock from hypovolemic shock A high index of suspicion should be maintained for spinal injury in polytraumatized patients.
Assessment of Injury
Accurate assessment of the spinal column in a trauma victim requires thorough initial and secondary evaluation. A detailed history and physical examination including neurologic evaluation is an essential step.
A complete assessment is not always possible in an unconscious, obtunded, sedated, or polytraumatized patient.
When spinal cord injury is present, neurologic injury can be scored according to the American Spinal Injury Association scale.
Anterior inspection can reveal abdominal and/or chest ecchymoses. The presence of a seat-belt injury should alert the clinician to the probability of an intra-abdominal injury. The posterior soft tissues should be inspected, and the spine should be palpated by log-rolling the patient. Any irregularity such as ecchymoses, bogginess, crepitus, open wounds, focal sites of tenderness, malalignment, or areas of palpable step-off should be noted.
Radioimaging
Xrays
Anteroposterior (AP) and lateral x-rays are usually obtained if spine is suspected to have an injury. Computed tomography with sagittal and coronal reconstructions is becoming an increasingly popular method of initial spine screening.
The AP view best demonstrates
- Any changes in coronal alignment
- Any changes in interpedicular distance
- Space between spinous processes.
A coronal translational deformity means a high-energy injury and mechanical instability. Normally, interpedicular distance increases as one moves from cranial to caudal along the spinal column, but comparison with adjacent levels provides a more reliable means of assessment.
Abnormal widening of the interpedicular distance signifies lateral displacement of vertebral body fragments, typical of burst fractures.
Abnormally increased distances between adjacent spinous processes suggest posterior ligamentous complex disruption.
Translation greater than 2.5 mm in eithersaggital or coronal plane suggests gross instability.
The lateral view
It is more useful in characterizing and detecting injuries and following things should be noted
- Sagittal plane malalignment
- Any vertebral body height loss
- Any break in spinous processes
Computed Tomography
It provides finer detail of the bony involvement in thoracolumbar injuries. Recent studes have shown that rapid chest, abdomen, and pelvis screening with CT scans is equally sensitive to but more efficient than standard plain x-ray in assessing thoracolumbar spine trauma.
Fractures of the pedicles, laminae, facets, and transverse processes are best detected and assessed with CT.
Magnetic Resonance Imaging
In acute cases MRI should be considered only if there is a neurologic deficit despite normal x-rays and CT imaging.
MRI provides better visualization of the spinal cord and soft tissues. MRI can help visualize disc herniations, epidural hematomas, or spinal cord edema that would not be detectable by other imaging modalities.
MRI has become an important tool in assessing the integrity of the posterior longitudinal ligament which in turn would dictate the mode of treatment that would follow.
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