Spinal injuries
Spinal injuries: Excerpt from Professional Guide to Diseases (Eighth Edition)
Spinal injuries (without cord damage) include fractures, contusions, and compressions of the vertebral column, usually as a result of head or neck trauma. The real danger lies in possible spinal cord damage. Spinal fractures most commonly occur in the 5th, 6th, and 7th cervical, 12th thoracic, and 1st lumbar vertebrae.
Causes and incidence
Most serious spinal injuries result from motor vehicle accidents, falls, dives into shallow water, and gunshot wounds. Less serious injuries result from heavy object lifting and minor falls. Spinal dysfunction may also result from hyperparathyroidism and neoplastic lesions.
Spinal cord injuries occur in 12,000 to 15,000 people per year in the United States. About 10,000 of these injuries cause permanent paralysis; many other patients die as a result of these injuries. Most spinal cord injuries occur in males between the ages of 15 to 35 years; about 5% occur in children. Mortality is higher in pediatric spinal cord injuries.
Signs and symptoms
The most obvious symptoms of spinal injury are muscle spasm and back pain that worsen with movement. In cervical fractures, pain may produce point tenderness; in dorsal and lumbar fractures, it may radiate to other body areas such as the legs. After mild injuries, symptoms may be delayed for several days or weeks. If the injury damages the spinal cord, clinical effects range from mild paresthesia to quadriplegia and shock.
Diagnosis
The diagnosis is typically based on the patient’s history, physical examination, X-rays, computed tomography (CT) scan, and magnetic resonance imaging (MRI).
The patient history may reveal a traumatic injury, a metastatic lesion, an infection that could produce a spinal abscess, or an endocrine disorder. The physical examination (including a neurologic evaluation) locates the level of injury and detects cord damage.
Spinal X-rays, the most important diagnostic measure, locate the fracture. In spinal compression, a lumbar puncture may show increased cerebrospinal fluid pressure from a lesion or trauma; a CT scan or MRI can locate a spinal mass.
Treatment
The primary treatment after a spinal injury is immediate immobilization to stabilize the spine and prevent cord damage; other measures are supportive. Cervical injuries require immobilization, using a type of cervical immobilization device (CID) on both sides of the patient’s head, a hard cervical collar, or skeletal traction with skull tongs or a halo device.
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 in 10 to 12 weeks). Later measures include exercises to strengthen the back muscles and use of a back brace or other device to provide support while walking.
An unstable dorsal or lumbar fracture requires a plaster cast, a turning frame and, in severe fracture, a laminectomy and spinal fusion.
When the spinal injury results in compression of the spinal column, 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 been immunized recently.
Special considerations
In all spinal injuries, suspect cord damage until proven otherwise.
❑ During the initial assessment and X-ray studies, immobilize the patient on a firm surface, with sandbags or CID on both sides of his head. Tell him not to move and avoid moving him yourself because hyperflexion can damage the cord. If you must move the patient, get at least three other members of the staff to help you logroll him to avoid disturbing body alignment.
❑ Throughout assessment, offer comfort and reassurance. Remember, the fear of possible paralysis will be overwhelming. Talk to the patient quietly and calmly. Allow a family member who isn’t too distraught to accompany him.
❑ If the injury requires surgery, administer prophylactic antibiotics as ordered. Catheterize the patient as ordered to avoid urine retention, and monitor bowel elimination patterns to avoid impaction.
❑ Explain traction methods to the patient and his family. Reassure them that traction devices don’t penetrate the brain. If the patient has a halo or skull-tong traction device, clean pin sites daily, trim hair short, and provide analgesics for persistent headaches. During traction, turn the patient often to prevent pneumonia, embolism, and skin breakdown; perform passive range-of-motion exercises to maintain muscle tone. If available, use a CircOlectric bed or Stryker frame to facilitate turning and to avoid spinal cord injury.
❑ Turn the patient on his side during feedings to prevent aspiration. Create a relaxed atmosphere at mealtimes.
❑ Suggest appropriate diversionary activities to fill the patient’s hours of immobility.
❑ Watch closely for neurologic changes. Immediately report changes in skin sensation and loss of muscle strength — either of which might indicate pressure on the spinal cord, possibly as a result of edema or shifting bone fragments.
❑ Help the patient walk as soon as the physician allows; he’ll probably need to wear a back brace.
❑ Before discharge, instruct the patient about continuing analgesics or other medication, and stress the importance of regular follow-up examinations.
❑ To help prevent a spinal injury from becoming a spinal cord injury, educate firemen, policemen, paramedics, and the general public about the proper way to handle such injuries.
Book Source Details
- Book Title: Professional Guide to Diseases (Eighth Edition)
- Author(s): Springhouse
- Year of Publication: 2005
- Copyright Details: Professional Guide to Diseases (Eighth Edition), Copyright © 2005 Lippincott Williams & Wilkins.
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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