OVERVIEW

What is a spinal injury?

As the name suggests, a spinal injury involves damage to the spinal structures, which may affect the bony structures of the spine, manifesting as fractures, dislocations, or ligament injuries. It may also involve the critical neural structures housed within the spine—the spinal cord—resulting in severe spinal cord injuries.

Minor spinal injuries, such as spinal compression fractures, can usually heal with appropriate treatment. However, spinal injuries accompanied by spinal cord damage lead to permanent and irreversible spinal cord injury.

Is the impact of spinal injury significant?

The spine serves as the central axis of the human body, not only supporting the body but also housing the spinal cord and nerve roots. Spinal injuries either impair the body's ability to stand upright or compress the spinal cord, leading to quadriplegia or paraplegia. For the injured individuals and their families, such injuries are catastrophic and permanently alter their lives.

Prevention is the only effective strategy.

Is the incidence of spinal injury high?

With the widespread use of motor vehicles, the incidence of spinal injuries has been increasing both domestically and internationally.

Statistics show that in the United States, thoracolumbar spinal injuries increased at an annual rate of approximately 8% from 1998 to 2011. In Queensland, Australia, one person suffers a spinal cord injury every four days, totaling 90 cases annually. In China, from 2001 to 2007, there were 82,720 cases of spinal injuries, including 13,955 cases with spinal cord injuries, and these numbers have been rising yearly. This translates to 32 spinal injuries and 5 spinal injuries with spinal cord damage per day. After 2007, especially in recent years, the surge in motor vehicle numbers has undoubtedly driven the incidence of spinal injuries beyond these already alarming statistics.

What types of spinal injuries are there?

Spinal injuries include: spinal fractures, spinal fractures with dislocations, spinal fractures with spinal cord injuries, and spinal fractures and dislocations with spinal cord injuries.

Simple spinal fractures are the most common type of spinal injury. Fractures and dislocations of the spine most frequently occur in the cervical region. Spinal cord injuries are also most common in the cervical spine, followed by the thoracic and lumbar regions.

Notably, there is also a type of spinal cord injury without fracture or dislocation, such as whiplash injuries to the neck caused by sudden braking while sitting in the passenger seat, which can damage the cervical spinal cord.

SYMPTOMS

Which areas of the spine are prone to injury?

Longitudinally, the spine consists of 7 cervical vertebrae, 12 thoracic vertebrae, 5 lumbar vertebrae, 1 sacrum, and 1 coccyx, connected by ligaments, joints, and intervertebral discs, forming the central axis of the human body.

Transversely, the vertebral body at the front, the posterior elements at the back, and the bilateral vertebral arches in the middle constitute the basic bony structure of the spine. Within this bony structure lies the spinal cord, the body's neural pathway. In the cervical region, it is the cervical spinal cord, which controls areas below the neck and serves as the primary neural pathway. In the thoracic region, it is the thoracic spinal cord, controlling areas below its corresponding level and serving as the secondary neural pathway, typically ending below the L1 vertebra. Below L1 are the cauda equina and nerve roots, which control the lower limbs and bladder/bowel functions.

Based on these structural characteristics, the cervical and lumbar regions are highly mobile, while the thoracic region is less mobile. Therefore, the thoracolumbar junction and lumbar spine are most prone to injury, accounting for more than half of cases, followed by the thoracic, cervical, and sacrococcygeal regions.

What are the symptoms after a spinal injury?

Symptoms after a spinal injury include: localized pain, swelling, tenderness, spinal deformities (such as kyphosis caused by compression fractures or specific deformities caused by spinal dislocation), and manifestations of spinal cord injury.

How dangerous is a cervical spine injury?

The human cervical spine has 7 vertebrae, with the first and second vertebrae being the atlas and axis, located deep and adjacent to the brainstem. The C3-4 cervical spinal cord controls the diaphragm, a crucial muscle for respiration, also known as the respiratory center.

Thus, injuries to the upper cervical spine are the most dangerous, as they can impair breathing and threaten life, potentially causing quadriplegia. Injuries to the lower cervical spine may affect movement, sensation, and bladder/bowel function below the shoulders and elbows, potentially leading to quadriplegia, incomplete upper limb paralysis, or lower limb paralysis.

What are the complications of spinal injury combined with spinal cord injury?

• Prolonged bed rest may lead to hypostatic pneumonia or lung infections;
• Urinary incontinence or indwelling catheters may cause urinary tract infections or stones;
• Inability to move the limbs may result in muscle atrophy and joint stiffness;
• Loss of nerve supply and nutrition to the skin, combined with bed rest, may cause pressure sores in the sacral region;
• Deep vein thrombosis may form, impairing blood return and causing swelling in the lower limbs;
• Embolism may occur, leading to pulmonary embolism, which can be life-threatening.

CAUSES

What are the causes of spinal injuries?

Spinal injuries are mostly caused by traumatic force, and osteoporosis is also one of the significant contributing factors.

Specifically, the causes of spinal injuries include:

• Traffic accident trauma: Motor vehicle accidents are the leading cause of spinal injuries, accounting for one-third of all cases. A small portion of traffic-related spinal injuries are caused by bicycle or electric vehicle accidents, though the proportion is relatively low.
• Falls from heights and slips: The secondary causes of spinal injuries are falls from heights and slips, accounting for more than half of all cases.
• Other traumatic factors: These include assault injuries, burns, scalds, and military training-related injuries, making up about 20% of all spinal injuries.

Who is more prone to spinal injuries?

Men are more susceptible to spinal injuries than women, and the majority of cases occur in young and middle-aged adults between 20 and 60 years old. Children under 10 are more likely to suffer cervical spine injuries, while elderly individuals over 60 are prone to osteoporotic thoracic and lumbar spine injuries (fractures), which is also a major reason for the gradual development of a hunched back in older adults.

Why do outcomes of spinal injuries vary so greatly?

The outcomes of spinal injuries often differ due to variations in the injury location, severity, and whether spinal cord damage is involved. Mild cases may heal with conservative treatments such as bed rest or wearing braces, while severe cases, such as cervical spine injuries with spinal cord damage, can be fatal (e.g., fractures of the second cervical vertebra—the axis—caused by hanging). Even injuries at the same spinal level can have different outcomes depending on the intensity of the external force.

What are the determining factors for spinal injury outcomes?

The most critical factor in determining the outcome of a spinal injury is the severity of the injury at the time of occurrence, i.e., the magnitude of the external force. Secondary factors include the structural integrity of the spine itself—such as flexibility, the presence of osteoporosis, and whether the spinal canal is narrowed.

For example, individuals with cervical spinal stenosis may not exhibit symptoms under normal circumstances, but even a minor external force, such as a fall, can lead to severe consequences like quadriplegia.

DIAGNOSIS

What tests should be done for spinal injuries?

For patients suspected of having a spinal injury, a detailed trauma history should first be obtained. Consultation with a professional and experienced spine surgeon is necessary. Through physical examinations—including localized assessments, upper and lower limb neurological function tests, and perineal sensation checks—the potential injury site and severity can be determined. Based on this, appropriate X-ray examinations should be performed, such as anteroposterior and lateral lumbar spine films, anteroposterior and lateral thoracic spine films, thoracolumbar spine films, or anteroposterior and lateral cervical spine films. If injury to C1 or C2 is suspected, an open-mouth cervical spine X-ray should also be taken.

Are CT and MRI necessary for spinal injuries?

X-rays provide basic information about spinal injuries, such as the presence of fractures, dislocations, and their severity.

CT scans offer clear cross-sectional images of the spine, allowing for a better understanding of the injury's extent and whether there is spinal canal compression. Advanced 3D reconstruction CT can rebuild the spine and provide multi-angle views, enabling a highly detailed assessment of the injury.

However, for suspected spinal cord injuries, MRI (magnetic resonance imaging) is required for accurate evaluation. Recent studies indicate that MRI is superior to CT in assessing acute spinal cord injuries, particularly for soft tissue and intradural damage.

What are the advantages of MRI for spinal injuries?

MRI, through different phases, clearly displays the spine's bony structures, ligaments, and spinal cord. It helps determine whether a spinal fracture is fresh or old, the degree of spinal cord compression, the termination level of the spinal cord (conus medullaris), and the severity of spinal cord injury. Importantly, MRI can diagnose spinal cord injuries without fractures or dislocations by detecting abnormal signals within the spinal cord.

TREATMENT

How to Properly Transport Someone After a Spinal Injury?

This is a very important issue!

Improper handling of a spinal injury victim can cause secondary damage, potentially leading to new spinal cord injuries where none existed before.

For any type of spinal injury, the victim should be moved as a whole unit—shoulders, pelvis, legs, and head together.

First responders should assess scene safety, then check the victim's limb mobility to determine the injury site. If a neck injury is suspected, stabilize the neck with slight traction and move the body as one unit. If breathing and pulse are stable, wait for professional rescuers with specialized equipment like cervical collars or scoop stretchers. In life-threatening emergencies where waiting isn't an option, transport the victim in a rigid position (e.g., on a door plank) to immobilize the spine.

How to Self-Rescue After a Spinal Injury at the Scene?

If conscious, first call emergency services (120). Note areas of pain—significant spinal pain suggests possible spinal injury. Attempt limb movement; free mobility rules out severe fractures or spinal cord damage. If movement is impaired, stay calm, control breathing, and await rescue.

Alert rescuers to potential spinal cord injury for careful handling.

What Are the General Treatment Principles for Spinal Injuries?

The core principle: Life before function.

Address life-threatening injuries first, then focus on spinal function. Stable spinal injuries without cord damage often require conservative treatment; unstable injuries with cord damage typically need surgery.

What Are the Goals of Surgical Treatment for Spinal Injuries?

The spine's natural curves—cervical lordosis, thoracic kyphosis, lumbar lordosis—are crucial for upright posture. Injuries often disrupt these, causing deformities. Surgery aims to:

• Restore spinal curves and support;
• Decompress to aid spinal cord recovery;
• Stabilize the spine.

What Is the Recovery Rate for Spinal Injuries?

Overall, over 90% of cases achieve cure or functional recovery.

Lumbar injuries have the highest cure rates; cervical injuries the worst prognosis and highest costs. Mortality: 0.56% (male), 0.23% (female). Patients under 60 show higher cure rates; over 60, higher recovery rates.

How to Treat Cervical Spine Injuries Without Spinal Cord Damage?

Treatment varies by injury type. For example:

Upper cervical fractures may be reduced via imaging-guided traction and fixed with a Halo vest. Lower cervical compression fractures may only require a cervical collar.

Is Surgery Beneficial for Cervical Injuries with Spinal Cord Damage?

For quadriplegic patients, even aggressive surgery rarely restores limb function, sensation, or bowel/bladder control due to spinal cord irreversibility. Surgery mainly offers stabilization, with limited benefits. Costly ICU stays post-op warrant careful patient-surgeon discussion. For incomplete paralysis, early decompression surgery may aid nerve recovery.

Does Surgery Help Thoracic Spine Injuries with Cord Damage?

Thoracic injuries with cord damage (often preserving arm function) have better prognoses than cervical cases. For complete paraplegia, surgery aims to stabilize for wheelchair use, though some nerve recovery is possible. Incomplete paraplegia warrants early surgery to optimize nerve recovery.

When Is Surgery Needed for Spinal Compression Fractures?

For common thoracolumbar compression fractures: <50% compression without cord damage may be treated conservatively (e.g., prone positioning with padding). Even with bone fragments, long-term follow-up shows spinal canal self-remodeling. Surgery is considered for >50% compression or clear cord damage.

Is Surgery Necessary for Thoracolumbar Burst Fractures Without Nerve Symptoms?

Common in axial stress injuries without displacement, these fractures show similar outcomes with conservative care (early bracing/mobility) versus surgery. Recent studies support brace-free early mobility as cost-effective, suggesting conservative management.

What’s the Optimal Surgery for Unstable Spinal Fractures?

Debate persists on anterior, posterior, or combined approaches. Cervical fractures often use anterior surgery; locked facets may need posterior release first. Thoracic fractures typically use posterior approaches. Thoracolumbar fractures balance pros/cons: posterior-only risks alignment loss but is less invasive; combined approaches improve stability but increase trauma. Decisions should weigh patient benefit and cost.

When Can Patients Bear Weight Post-Spinal Fracture Surgery?

Depends on fracture severity and post-op stability. Cervical fractures with Halo vests allow early mobility; thoracic/lumbar cases require bracing until initial healing. Premature weight-bearing risks hardware failure.

Should Spinal Hardware Be Removed Post-Surgery?

Modern titanium implants (MRI-compatible) often remain unless causing discomfort or failing. Anterior cervical plates are usually retained; posterior systems may stay unless problematic.

What’s New in Spinal/Spinal Cord Injury Treatment Research?

No clinically proven therapies yet exist for cord repair. Stem cell transplants and bioactive scaffolds are under study. For osteoporotic fractures, cement-augmented screws (though irremovable) are being explored to enhance fixation. Spinal specialists continue pursuing better solutions.

DIET & LIFESTYLE

How should patients with spinal cord injuries and their families live and care at home after discharge?

Regarding complications of spinal cord injuries, patients and families who have unfortunately experienced such injuries undergo surgery and meticulous medical treatment, creating conditions for recovery.

If conditions permit, they can learn rehabilitation knowledge in the hospital's rehabilitation department, including massage and exercises for upper and lower limb joints and muscles, as well as bladder training to improve urinary control.

If conditions do not allow, after returning home, caregivers should actively help the patient turn over to prevent pressure sores; perform deep back patting daily and assist with expectoration by pressing the thoracoabdominal junction when the patient coughs to avoid lung infections; encourage drinking plenty of water and bladder training to prevent urinary tract infections and stones; frequently wipe the body, massage and exercise the joints and muscles of the limbs to prevent deep vein thrombosis; communicate often with the patient, offer encouragement, and help build confidence in living—psychological support is crucial.

PREVENTION

How to Prevent Spinal Injuries?

The causes of spinal injuries include traffic accidents, falls, and other impacts. Preventive measures include:

• Always wear a seatbelt when in a vehicle;
• Drivers should maintain a safe distance, control speed, avoid fatigue, and never drive under the influence of alcohol;
• Workers, especially those at heights, should take proper safety precautions;
• Elderly individuals with osteoporosis should get adequate sunlight, engage in moderate exercise, and avoid injuries;
• People with cervical spinal stenosis should protect their necks to prevent serious consequences from trauma.

Stay vigilant and prioritize safety for yourself and your family.