Spinal InjuriesAside from spinal cord damage, spinal injuries include fractures, contusions, and compressions of the vertebral column, usually the result of trauma to the head or neck. The real danger lies in possible spinal cord damage. Spinal fractures most commonly occur in the 5th, 6th, and 7th cervical, 12th thoracic, and first lumbar vertebrae.
CausesMost serious spinal injuries result from motor vehicle accidents, falls, diving into shallow water, and gunshot wounds; less serious injuries, from lifting heavy objects and minor falls. Spinal dysfunction may also result from hyperparathyroidism and neoplastic lesions.
Signs and symptoms
Typically, a diagnosis is based on the patient history, the physical examination, X -rays and, possibly, lumbar puncture, computed tomography (CT) scan, and magnetic resonance imaging (MRI).
The primary treatment after spinal injury is immediate immobilization to stabilize the spine and prevent cord damage; other treatment is supportive. Cervical injuries require immobilization, using sandbags on both sides of the patient's head, a hard cervical collar, or skeletal traction with skull tongs or a halo device. When patients show clinical evidence of cord injury, high doses of methylprednisone are started.
Treatment of stable lumbar and dorsal fractures consists of bed rest on firm support (such as a bed board), analgesics, and muscle relaxants until the fracture stabilizes (usually 10 to 12 weeks). Later treatment includes exercises to strengthen the back muscles and a back brace or corset to provide support while walking.
An unstable dorsal or lumbar fracture requires a plaster cast, a turning frame and, in severe fracture, laminectomy and spinal fusion.
When the damage results in compression of the spinal colunm, neurosurgery may relieve the pressure. If the cause of compression is a metastatic lesion, chemotherapy and radiation may relieve It. Surface wounds accompanying the spinal injury require tetanus prophylaxis unless the patient has had recent immunization.
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