Spine Injuries: Causes
Last reviewed: 23.04.2024
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Damage to the spinal cord
In the United States, an average of more than 10,000 spinal cord injuries occur throughout the year. Approximately 40% occur in road traffic accidents and 25% occur as a result of violent actions, the rest are related to falls, sports and industrial injuries. More than 80% of patients are men.
Damage to the spinal cord occurs with the direct physical impact of a force that damages the vertebra, ligaments or discs of the spine and causes crushing or rupturing of the spinal cord tissue, and with penetrating spinal cord injuries (gunshot or stab wounds). Such effects can also damage the vessels with the formation of ischemia or bruising (usually extradural), aggravating the trauma. All types of damage can cause spinal cord edema, further worsening blood flow and oxygenation. Damage can be caused by excessive release of neurotransmitters from damaged cells, an inflammatory immune response with ejection of cytokines, accumulation of free radicals and apoptosis.
[Damage to the vertebrae
Bony lesions include fractures and dislocations. In the fracture, the bodies, arches and processes of the vertebrae (carpal and transverse) may be involved. Dislocations are displacements of articular surfaces of vertebral bodies in relation to each other. Subluxations of the vertebrae occur due to damage to the ligaments without fractures of the bones. In the cervical region, fractures of the posterior elements and dislocation can damage the vertebral arteries and cause pseudo-abscess syndrome.
Unstable injuries of the spine involve a combination of vertebral fractures and ligament ruptures, which can lead to a displacement of the overlying vertebra relative to the underlying one with compression of the spinal cord or a violation of its blood supply, which significantly worsens the neurologic function or causes severe pain. Such displacements are possible even if the patient's position changes (for example, during transportation, during the initial examination). Stable fractures to such movements are stable.
Specific damage usually varies depending on the mechanism of injury. Flexural injuries can cause wedge fractures of vertebral bodies or fractures of spinous processes. In case of excessive bending, bilateral bias of vertebral facets is possible, or, if it occurs at C1-C3 level, a tooth fracture and / or atlanto-osciplital or atlantoaxial subluxation occurs. Rotational damage can cause a one-sided displacement of facet facets. Extensor damage can cause a fracture of the vertebrae. Compression damage can cause "explosive" fractures of vertebral bodies.
Ponytail damage
The lower part of the spinal cord (conus medullaris) usually begins at level C. Spinal nerves below this level form a pony tail. With lesions in this zone, there are no characteristic signs of damage to the spinal cord.