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Spinal injuries
Last reviewed: 12.07.2025
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Causes of spinal injury
In the United States, an average of more than 10,000 spinal cord injuries occur each year. Approximately 40% are caused by motor vehicle accidents and 25% are the result of violence, with the remainder due to falls, sports, and work-related injuries. More than 80% of patients are men.
Spinal cord injuries occur when there is direct physical force that damages a vertebra, ligaments, or discs of the spinal column, causing crushing or rupture of spinal cord tissue, and when there is penetrating injury to the spinal cord (gunshot or knife wounds). Such impacts may also damage blood vessels, causing ischemia or hematomas (usually extradural), which aggravate the injury.
Symptoms of spinal injury
A reliable sign of spinal cord injury is a clear definition of the level of injury, above which there are no neurological changes, and below which neurological functions are either completely absent or significantly reduced. The features of clinical manifestations depend on the level and degree of spinal cord injury (complete or partial).
Spinal injuries, like other fractures or dislocations, are very painful, but patients suffering from pain caused by other concomitant injuries (eg, long bone fractures) or with impaired consciousness due to intoxication or TBI may not complain of back pain.
Spinal cord injuries in children
Although spinal cord injuries are less common in children <10 years of age than in other age groups, they do occur. Any child who has been in a motor vehicle accident, fallen from a height greater than 10 feet, or suffered a swimming injury should be considered to have a spinal cord injury until proven otherwise by testing, including imaging.
In children <8 years of age, cervical spine injuries are usually located above C4, and in children >8 years of age, the level between C5 and C7 is most often affected. In pediatric patients, recognition of spinal cord injury without obvious findings on plain radiography is of great importance. This type of spinal cord injury occurs almost exclusively in children and is associated with direct traction of the spinal cord, concussion, or vascular injury.
Treatment is similar to that in adults, with immobilization and careful monitoring of oxygenation, ventilation, and circulation, and may include high-dose glucocorticoids (based on the child's body weight). Children with severe spinal injury should be transferred to a specialized pediatric trauma center as soon as possible.
Where does it hurt?
Diagnosis of spinal injury
Spinal cord injuries are not always obvious from trauma. Injuries to the spine and spinal cord should be suspected in patients with TBI, pelvic fractures, penetrating injuries to the spine, after most motor vehicle accidents, and always after falls from heights or diving into bodies of water.
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Prognosis and treatment of spinal injury
Once completely cut or degenerated, nerve endings do not recover, and functional impairments become permanent. The compressed nerve tissue can regain its function. Restoration of movement and sensitivity in the first week after injury indicates a favorable prognosis. Dysfunction that persists for more than 6 months after injury is likely to become permanent.