Injury to the spinal cord is a serious condition that can have potentially catastrophic ramifications in a person’s ability to function normally. The injury, or ‘lesion’, of the cord may cause quadriplegia (complete or partial paralysis of all four limbs); paraplegia (complete or partial paralysis of the lower limbs only); loss of: skin sensation, bowel, bladder and/or sexual function as well as chronic painful conditions, depending on the location of the injury along the spinal cord. The nearer the brain the lesion happens, the more serious it is, affecting all levels of the body below it and can be potentially life threatening if the nerves to the heart and lungs are involved. Even if the casualty is not as severe as to cause neurological deficit, spinal injury may cause chronic back pain and restricted spinal flexibility. Spinal injuries can be caused by a variety of physical incidents. A common cause of spinal injuries is motorcycle accidents. Riders and pillion passengers are thrown unprotected to the roadway and invariably land heavily in an awkward manner, putting stress on the back and injuring the spinal column. It is very important to know of the mode of injury and complaints of pain and weakness before primary care giver attempt to move the patient.
About 47% of patients with spinal injury also have an associated injury involving head (26%), chest (24%) and long bones (24%).
Spinal Column Anatomy: The spinal column consists of a series of interconnected bones, called vertebrae, which protects the spinal cord, an integral part of the central nervous system. It is the spinal cord and its attached nerves which provides the means by which we breathe, move and use our senses. Between each vertebra are discs of cartilage that act as shock absorbers and allow the spinal column a degree of flexibility. The spine is divided into five areas from top to bottom:
- The cervical spine (neck), 7 vertebrae
- The thoracic spine (chest), 12 vertebrae
- The lumbar spine (back), 5 vertebrae
- Fused vertebrae of the sacrum
- A small set of vertebra called the coccyx or the tail bone.
Warning signs for possibility of Spinal Injury:
- Strongly suspect spinal injury in case of any major accident, unconscious patient, fall from a height, and sudden jerk of neck after rear end car collision, facial injuries or head injury.
- pulse may be fast or slow and is not generally a helpful indication of presence or severity of a spinal injury
- unnatural posture
- may have pale, cool, clammy skin
- ‘tingling’, unusual, or absent feeling in limbs
- absence of pain in limbs despite other injuries to these areas
- inability to move arms and/or legs, or weakness of movement
- onset of shock
- Uncontrolled penile erection occasionally occurs.
Care and Treatment: Three most important things in managing spinal injuries is ABC, Hard Board and cervical Collar.
ABC: This is an acronym used for airway, breathing and circulation. If airway is not open, use jaw thrust or manual opening of the jaw rather than extending the neck. If unable to control airway – carefully remove the helmet while ensuring the minimum of neck movement.
Patient may be suffering from Spinal shock which refers to changes in blood pressure associated with injury to the spine. The blood pressure is usually lower than normal (as in shock due to blood loss), however, the pulse is usually normal or slow (the opposite of shock due to blood loss). The skin may be cold and clammy as a result. If trained paramedic is present on the spot, he may start treatment to ensure proper breathing and prevent/treat shock.
Hard Board: The casualty’s head is maintained in line with the shoulders and spine using manual support on a hard board. Ensure the head is supported, not pulled or pushed in any direction. If movement required, ‘log roll’ using 2-3 assistants.
Cervical Collar: Excessive neck movement can convert a stable injury without any neurological deficit into one with paraplegia or quadriplegia. The patient’s neck movement should be controlled so that there is no hyperextension or flexion, especially during the efforts to establish an airway. The patient should be immediately put in a cervical collar to prevent these movements.
Treat any other injuries: If trained, immobilize any other fractures or injuries. Helmet removal: Helmets should only be removed if you intend to perform CPR or if the helmet is impeding proper airway management. Otherwise, leave helmet removal to the experts. The helmet could be helping prevent (further) spinal or head injuries.