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Spinal Injuries - Causes
Last reviewed: 06.07.2025
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Spinal cord 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 a direct physical force damages a vertebra, ligament, or disc of the spinal column, causing crushing or rupture of spinal cord tissue, or when penetrating injuries to the spinal cord (gunshot or knife wounds) occur. Such impacts may also damage blood vessels, causing ischemia or hematomas (usually extradural), which worsen the injury. All types of injuries may cause swelling of the spinal cord, further impairing blood flow and oxygenation. Damage may be caused by excessive release of neurotransmitters from damaged cells, an inflammatory immune response with cytokine release, accumulation of free radicals, and apoptosis.
[ Vertebral injuries
Bone injuries include fractures and dislocations. A fracture may involve the bodies, arches, and processes of the vertebrae (spinous and transverse). Dislocations are displacements of the articular surfaces of the vertebral bodies relative to each other. Subluxations of the vertebrae occur due to damage to the ligaments without bone fractures. In the cervical spine, fractures of the posterior elements and dislocations may damage the vertebral arteries and cause pseudostroke syndrome.
Unstable spinal injuries involve a combination of vertebral fractures and ligament ruptures, which can result in displacement of the overlying vertebra relative to the underlying one, with compression of the spinal cord or disruption of its blood supply, significantly worsening neurological function or causing severe pain. Such displacements are possible even when the patient's body position changes (e.g., during transportation, during the initial examination). Stable fractures are resistant to such displacements.
Specific injuries usually vary depending on the mechanism of injury. Flexion injuries may cause wedge fractures of the vertebral bodies or spinous process fractures. Excessive flexion may cause bilateral facet displacement or, if at the C1-C3 level, odontoid fracture and/or atlanto-occipital or atlanto-axial subluxation. Rotational injuries may cause unilateral facet displacement. Extension injuries may cause vertebral arch fractures. Compression injuries may cause burst fractures of the vertebral bodies.
Damage to the equine tail
The lower part of the spinal cord (conus medullaris) usually begins at the level of the C. The spinal nerves below this level form the cauda equina. Injuries in this area do not show characteristic signs of spinal cord injury.