Emergency Neurological Conditions

Spinal injury

Spinal injury can have very devastating effects, resulting in paralysis and loss of bowel and bladder function, as well as sensation. Most cases of spinal injury are caused by either falls or motor vehicle accidents. Some cases are the result of violence, usually gunshot wounds. When the spinal cord is inured there is the possibility of a loss of function at all spinal cord levels below the injury level.

Spinal injury can involve injury to the bones of the spine, the spinal cord itself, or both. Usually there has to be injury to the spinal cord and nerves for paralysis or loss of neurological function to occur. If the bones are injured, there may or may not be associated injury to the spinal cord. Injury to the bones usually results in a vertebral fracture, or fracture of the spinal bones. A vertebral fracture may cause spinal cord injury because along with a vertebral fracture there is injury to the ligaments of the spine. These ligaments hold the spine in place. When they are injured, the bones of the spine can slip on one another, compressing the spinal cord. Injury to the spinal cord itself usually is a result of broken spinal bones or slipping spinal bones compressing the spinal cord. With missile injury, such as gunshot wounds, there is direct penetrating injury to the spinal cord, usually devastating.

The immediate goal of therapy is to stabilize the injured spine. While the normal spine has restricted movement, controlled by muscles and ligaments, the injured spine may not. Therefore, attempts at movement may further injure the spinal cord. Stabilization may require a stiff collar, immobilizing vest or even tongs placed on the skull connected to a vest. Sometimes, tongs are driven onto the skull and connected to weights. This is done to distract the injured spine and restore normal alignment.

Usually surgery is required. The goal of surgery is to stabilize the spine to prevent further injury. This usually requires immobilization of the injured segment. This is accomplished by fusing the involved spinal level and sometimes even removing the fractured bone. This involves placing screws and rods to connect the intervening spinal segment. The spinal joints are then fused by removing the normal joints and placing bone between them.