Definition

Trauma to the vertebrae (spine) can cause damage to the spinal column, possibly leading to fractured bones or spinal cord injury. The spinal cord, which is located within the spinal column, transmits electrical signals between the brain and the rest of the body, allowing for sensation and movement.

Damage to the spine can lead to vertebral fractures or dislocations (subluxations). Such injuries may cause acute spinal cord injury. Spinal cord injuries due to trauma can be partial or complete. The global incidence of vertebral trauma is estimated at 10.5 per 100,000 people, with a higher frequency in low- to middle-income countries. There is currently no data on the incidence of vertebral trauma in Indonesia.

Causes

The most common causes of spinal trauma are traffic accidents, followed by falls. Various types of trauma can compress and bend the spine, including:

• Falling from a height
• Motor vehicle accidents (cars, motorcycles, or pedestrian accidents)
• Sports injuries
• Diving accidents
• Trampoline accidents
• Violence (gunshot or stab wounds)
• Infections (abscesses in the spine)
• Congenital defects (typically affecting the cervical spine)

Risk factor

Risk factors for severe spinal trauma include osteoporosis, which decreases bone density over time, making minor falls potentially fracture-prone. Men are more likely to sustain spinal injuries than women. Other risk factors include:

• Ages 16-30 or over 65
• Alcohol consumption
• Engaging in high-risk activities like sports without protective gear

Symptoms

Spinal trauma can cause pain, loss of height, and spinal deformities. The thoracic region (middle part of the spine), especially the lower part, is most frequently fractured. Trauma can result in either fractures or dislocations:

• Compression fractures: Typically caused by hyperflexion (bending) of the neck, leading to vertebral compression and cracking.
• Burst fractures: More severe, where the bone shatters into smaller pieces, potentially damaging the spinal cord.
• Subluxation: Vertebral dislocation due to weakened joints from abnormal movement, possibly damaging the spinal cord.
• Dislocation: More severe than subluxation, causing vertebral displacement and damaging surrounding structures.
• Fracture dislocation: When fractured vertebrae move, severely damaging surrounding muscles and ligaments, including the spinal cord.

If trauma damages the spinal cord, symptoms can include:

• Urinary and bowel dysfunction
• Breathing, heart rate, and muscle movement problems, including respiratory and limb muscles
• Reflex and sensory disturbances
• Metabolic disorders
• Symptoms can range from mild to severe, depending on the injury location. Higher injuries typically result in more severe symptoms, with the most severe being paralysis of the limbs. Types of paralysis include quadriplegia (paralysis of all four limbs) and paraplegia (paralysis of the lower body).

Diagnosis

In emergencies, initial assessment focuses on breathing and heart function. Healthcare providers will secure the airway and cardiac function to prevent life-threatening situations. Subsequent evaluations will assess limb movement and review the patient's medical history or incident details. Diagnostic tests for spinal trauma include:

• Blood tests
• X-rays: To examine bones and internal organs using X-ray energy
• CT scan: Combines X-rays and computer technology for detailed cross-sectional images
• MRI: Uses high-strength magnets and computers to produce detailed images of internal organs and structures, though it takes longer than a CT scan
• EMG: Electromyography assesses electrical activity in muscles and nerves

Management

Currently, no cure exists for permanent spinal cord damage. Treatment focuses on stopping symptom progression and providing early therapy. In emergencies, surgery may be performed to repair fractures or dislocations, and high-dose corticosteroids may be administered to reduce inflammation.

Complications

Initially, spinal damage causes severe symptoms that may improve as inflammation and swelling decrease. However, severe complications can include:

• Urinary dysfunction: Nerve damage may prevent the sensation of needing to urinate, though urine production continues if the kidneys are intact
• Bowel dysfunction: Nerve damage can impair bowel movements
• Skin damage from prolonged pressure: Ulcers occur when skin is pressured for too long, and nerve damage prevents the skin from signalling damage
• Circulatory issues
• Breathing problems
• Reduced bone density
• Muscle abnormalities (too rigid or weak)
• Chronic pain
• Sexual dysfunction
• Depression

Prevention

Best practices for preventing spinal trauma include:

• Using proper safety equipment, such as seat belts, when driving
• Checking water depth before diving
• Preventing falls, such as using step stools for high objects
• Taking precautions during sports to avoid injuries
• Not driving under the influence of alcohol

When to see a doctor?

If you or someone close to you has recently been in an accident involving the neck or spine or has fallen from a height and experiences any of the following symptoms, seek immediate medical attention:

• Severe pain in the back, neck, or another part of the body
• Weakness or paralysis in the limbs
• Numbness or tingling in the fingertips or toes
• Loss of urinary or bowel function
• Difficulty walking or standing
• Breathing difficulties post-accident
• Twisted or abnormal neck position

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