Spine TraumaThe spine is a complex biomechanic and neural structure. The spine provides structural support for the body as the principal component of the axial skeleton, while protecting the passing spinal cord and nerve roots. Trauma may fracture bones or cause ligamentous disruption. Often bone and ligament damage occur together. Damage to these elements reduces the strength of the spine and may cause the spine to be unstable. This compromises both its structural support function and its ability to protect neural elements. Spine trauma may occur with or without neurologic injury. Neurologic injury from spine trauma is classified as either incomplete, if there is some residual motor or sensory neurologic function below the level of the lesion, or complete, if there is no residual neurologic function below the level of the lesion, as assessed by clinical exam. 7 A patient with complete neurologic dysfunction persisting 24 hours after injury has a very low probability of return of function in the involved area.
Neurologic injury from spine trauma may occur immediately or in delayed fashion. Immediate neurologic injury may be due to direct damage to the spinal cord or nerve roots from penetrating injuries, especially from stab wounds or gunshots. Blunt trauma may transfer sufficient force to the spine to cause acute disruption of bone and ligament and lead to subluxation, which is shift of one vertebral element in relation to the adjacent level. Subluxation decreases the size of the spinal canal and neural foramina, and causes compression of the cord or roots. Such neural impingement can also result from propulsion of bone fragments into the canal during a fracture. Transection, crush injury, and cord compression impairing perfusion are mechanisms leading to spinal cord injury. Delayed neurologic injury may occur during transportation or examination of a patient who is not properly immobilized.
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