Spinal Injuries - Principles

Complications of spinal injury

• Neurological damage

• Damage to vertebral column causing deformity and pain

Stable injuries

• Vertebral components won't be displaced by normal movement.

• An undamaged spinal cord is not in danger

• There is no development of incapacitating deformity or pain

Unstable injuries

• Further displacement of the injury may occur

• Loss of 50% of vertebral height

• Angulation of thoracolumbar junction of > 20 degrees

• Failure of at least 2 of Denis's 3 columns

• Compression # of three sequential vertebrae can lead to posttraumatic kyphosis

Anatomical considerations

• The upper thoracic spine (T1-T10) is protected by the ribs, sternum and the facet joint orientation

• At the thoracolumbar junction there is a fulcrum of increased motion, so there is increased risk of injury

• The middle thoracic spine is a vascular 'watershed', vascular insult can cause cord ischaemia

  (Artery of Adamkiewitz)

• Cauda equina begins at L1-L2. Lesions below L1 have a better prognosis as nerve roots, not cord are affected