Neurotraumatology of The Spine

Spinal injury is a particularly  frequent  in young people especially after motor vehicle accidents or falling from heights.

The injuries may be a wedge shaped deformation (compression fracture) of a vertebral body, a burst fracture of the vertebra with pressure on neural structures, a fracture-dislocation at the fracture level with associated semi-transection or transection  of  the spinal cord or cauda equina and finally Spinal epidural and/ or subdural and/or intraspinal cord hematoma may occur as well as the possibility of intraspinal contusions and swelling.

Symptoms can range from pain in the injured area which extends to the limbs, paresthesias or dysesthesias of the extremities and torso (depending on the location of the lesion) to monoparesi, monoplegia, hemiparesis, hemiplegia, paraparesis, tetraparesis and tetraplegia which is a severe clinical manifestation of a cervical spine injury.

A complete physical and neurological examination is performed followed by diagnostics  initially X-Rays, followed by CT and MRI of the injured spine.

Depending upon the findings of the clinical examination and neuroimaging the further treatment of the injured is determined. Treatment may be simple support of vital signs, antiedemic and/or surgery to decompress the neural structures and the stabilize the spine.

More specifically for the stabilization of a simple compression fracture there is a choice of conservative rehabilitation with  bed rest for at least 3-4 weeks or, either  vertebroplasty or kypholasty aimed at the immediate mobilization of the patient, pain management and stabilization - reduction of the fracture.

In case of a burst fracture of the vertebral body the neural structures which are usually  compressed  by  the fracture  have to be decompressed and spinal fusion  performed to stabilize the spine.

The fracture-dislocation is an extremely urgent neurosurgical condition because of the severe clinical picture usually displayed by injured. Immediate decompression of the neural structures, restoration of normal spinal structure and stabilization with spinal fusion is required. Hematomas of the spine depending on the clinical and neurologic picture are treated either conservatively or surgically. Drainage of the hematoma depending on the intensity and preferred access point may require stabilization with fusion.

A period of 6 hours is critical in order to address the pressing injuries of the spine to the spinal cord. Beyond this "window period", the neurological signs may most probably not be able to be reversed and become permanent resulting in huge socioeconomic costs to the patient's family and society.

In cases of intraspinal contusion and swelling, careful monitoring with regular neurological check-ups  is advised  for early diagnosis of  deterioration and neuroimaging diagnostic testing of the findings  and / or regular monitoring  of the image changes of the lesions.

Another pathological condition which may also be traumatic is the automatically pathological osteoporotic fracture which usually occurs after a relatively routine activity in older patients and more commonly women. There is one permanent treatment, vertebroplasty or kyphoplasty.