Spinal Fractures and Dislocations
What is a Spinal Fracture?
The spine is composed of blocks of bone called vertebrae stacked one above the other with an intervening soft shock-absorber like tissue called a disc lying between each pair of vertebrae.
What causes it?
Normal vertebrae can fracture due to falls from a height, road traffic accidents and other high velocity accidents. Vertebrae can lose their strength due to osteoporosis and these osteoporotic vertebrae are susceptible to fractures from low velocity injuries. Massive injuries to the spine can result in a loss of the normal alignment of the spine – dislocations. Depending on the extent of the initial damage to the spinal cord, some spinal cord injuries are permanent whereas others recover over time.
What are the symptoms/effects?
Fractures and dislocations of the spine can lead to spinal cord and nerve root injury causing varying degrees of muscle paralysis, sensory alterations and loss of bladder and bowel control.
How are they diagnosed?
Fractures and dislocations are diagnosed by a thorough clinical examination, followed by xrays, CT scans and MRI scans. The CT scan reveals the extent of the bony injury whereas the MRI scan provides information regarding spinal cord compression and ligamentous injury.
What are the treatment options?
There are two issues here – a) bone and ligamentous injury and b) neural injury. Many spinal fractures can be managed without surgery as bony injuries heal over time. However, in the presence of a massive ligamentous injury (e.g. fracture dislocations) operative stabilisation is advisable.
Complete damage to the spinal cord results in permanent paralysis and surgery does not alter the neurological outcome. However, surgical stabilisation in this instance may permit early institution of rehabilitation. Incomplete injuries may recover over time and there is a role for surgical decompression and stabilisation in this instance.
Who is at risk?/How can I prevent it?
Adhering to occupational health and safety rules and regulations, following traffic laws and avoiding excessive speed while travelling on the road will reduce the incidence of spinal cord injuries.