Spinal Cord Injuries: Symptoms and Spinal Compression

Spinal cord injuries are rightly classified as serious and dangerous conditions.

The spinal cord is securely stored in the spinal canal until an accident occurs. Even a seemingly insignificant event can cause spinal cord injury.

The spinal cord gets injured due to falls, falls from height, falls from a bicycle or a motorcycle, jumps into the pool, vehicle accidents and sudden braking in a vehicle.

These injuries also occur when participating in sports activities and performing daily activities.

The symptoms of injury include pain in the neck, head, and other parts of the back, limited mobility of the spine, loss of skin sensitivity and an inability to control the limbs.

The most serious spinal cord injuries are associated with a risk of developing secondary conditions that can be debilitating and life-threatening.

Quick reaction and determination of a spinal or spinal cord injury based on the mechanism of the injury,

prompt response and appropriate first aid, calling medical help,

giving a diagnosis and an appropriate course of treatment are crucial.

About 20 out of 100,000 people suffer a spinal injury each year. Of these, up to 80% are between the ages of 18 and 35, affecting more men.

Here is some statistical data:
55% of spinal injuries occur in vehicle accidents, 
22% of accidents occur at home or at work, 
18% of accidents occur in sports. 
40% of accidents are due to injuries of the cervical spine (neck). 
This is followed by injuries of the thoracic (chest) segment and less often the lumbar (lower spine) segment.

A spinal injury involves damage to various structures. It can be one or more vertebrae, intervertebral discs, ligaments or muscles.

For example, fractures, sprains, cases of subluxation or luxation, i.e. dislocation of bones and joints, soft structure injuries.

Severe injuries include serious damage to the spinal cord and spinal nerves.

The Spine - A Brief Overview

The vertebral column, the spine, the backbone, or columna vertebralis, is the axial support of the human body. It provides support, locomotion and protection.

Table: Anatomical Components of the Spine

Learn moreabout each spinal segment in the following articles:

• spondylolisthesis - spinal vertebra displacement - the vertebrae
• spinal disc herniation - the intervertebral discs
• facet syndróme - the intervertebral joints
• cauda equina syndrome - the so-called horse's tail
• coccygodynia - the coccyx
• radiculopathy - the spinal cord

Learn more by reading the article:
More details on spinal injuries, causes,

symptoms, which occur during injuries of individual

parts. We also briefly deal with diagnostics and

treatment. The importance of first aid and first responders.

About Spinal Injuries

This is about 5 percent of all injuries. High risk is mainly the risk of injury to the nervous system. And therefore the spinal cord and spinal roots or nerves.

Spinal cord injuries are also usually present in spinal cord injuries. To a lesser extent, injuries to the nervous system occur without concomitant spinal trauma.

Fortunately, in most cases, spinal injury is not accompanied by spinal cord injury.
About 50% of head injuries are associated with spinal cord injuries.

Spinal cord injury is a primary mechanical damage that can cause, for example:

Spinal cord injury is a primary mechanical damage that can cause, for example:

• concussion
• strain
• tear
• cut
• compression
• impingement by a hematoma or a spinal tumour

Secondary injury causes a disruption of the vascular supply, ie blood flow. It is caused, for example, by injury to the arteries, the vessels that nourish the spine, but also by thrombosis of these vessels or a reduction in flow due to shock.

Learn more in the following articles: 
Spinal tumours
Shock

An alternative spinal cord injury classification:

1. spinal cord concussion
2. incomplete spinal cord injury syndromes
   • incomplete, partial spinal cord injury
   • depending on the extent and the disorder of nervous functions to varying degrees
     • motor skills or sensitivity
   • classification:
     • central cord syndrome
     • anterior cord syndrome
     • posterior cord syndrome
     • Brown-Séquard syndrome
3. complete spinal cord injury
   • complete loss of sensitivity, motility and neurological functions below the level of injury

Injuries occur as a result of vertebral fractures, compression by bone fragments, also during penetration, i.e. penetrating injuries due to stabbing, cutting or firing.

There are a number of causes of backbone and spinal cord damage. However, symptoms of injury are not always apparent immediately after an injury.

Injuries are the result of hyperflexion, hyperextension and rotation. There is also a direct effect of pressure, physical force from the external environment.

The result is vertebral fractures, damage to the intervertebral discs, sprains and dislocations, ligaments or muscles.

Fracture = a partial or complete break in the continuity of a bone.

In the case of injuries, it is important to know the mechanism of the injury. The injury can be determined based on the speific mechanism.

Risk mechanisms:

1. vehicle accidents:
   • impacts at speeds higher than 60 km per hour
     • frontal impact of two moving objects = speed accumulation
   • on a motorcycle
   • crashes with pedestrians
   • cyclists
   • overturned vehicle after crashing
   • occupant ejected from the vehicle
   • driver's compartment deformation
   • occupant in a fatal accident
2. falling from height = higher than body height, critical height more than 3 meters
3. falling down the stairs
4. a child is dropped, especially on the head and face
5. hyperflexion and hyperextension of the neck
   • sudden braking of a vehicle
   • rear-end collision
   • sport activities
     • gymnastics
     • jumping on a trampoline
     • boxing and martial arts
     • contact sports with high-impact risk
   • jumping into water and hitting the bottom (jumping into a swimming pool)
6. impact of heavy loads on the head and back of the victim
7. head and face injuries

Motor vehicle accident:
2 passenger cars moving at a speed of 50 km/h
will be involved in a head-on collision
at 100 km/h. 

It is also dangerous to fall from height, for example on the protruding lower limbs, into a sitting on the buttocks, directly on the back or head. This happens when working on a ladder, the roof of the house, when falling from scaffolding, paragliding, when a climber falls off a wall, rocks.

Falls from a bicycle, motorcycle and horse at high speed are serious. Jumping into the pool during summer days is a high-risk activity.

If the person faints, it is necessary to suspect head and spine injuries. Spinal cord injuries in the neck area are especially serious.

The spinal cord can be damaged due to hyperflexion, shear and rotational forces, for example compression due to a broken vertebrae or dislocation from its normal position.

Similarly, oppression, compression is caused by spinal disc herniation or a hematoma - blood suffusion.

Secondary changes are caused by insufficient blood supply and vascular damage, bleeding into the spinal cord or its membranes.

Damage to the cervical spinal cord is an immediate, life-threatening injury.

The size of the spinal canal is also important in the event of an injury. It has different widths on different sections. The spinal cord thus occupies a different area in a narrow space.

Therefore, spinal cord segments in the C4 to C6 and Th11 to L2 regions are particularly affected. The condition of the already occurring narrowing of the spinal canal, i.e. spinal stenosis, is risky.

A specific type of spinal injury is...

A Pathological Spine Fracture

The condition occurs due to osteoporosis. Osteoporosis is a degenerative process, and therefore a thinning of the bone tissue. This reduces bone strength. This can result in bone fractures even after minimal injury.

Osteoporosis mainly affects postmenopausal women due to hormonal and metabolic changes. It is reported that up to 40% of women over the age of 65 have an osteoporotic vertebral fracture.

only 50% of people know about it and are treated.

Pathological damage also occurs in spinal tumours. However, it is stated that in most cases it is a secondary form of the tumour and metastasis to the bone, in this case to the spine.

The primary oncological lesion is located elsewhere in the body. In other cases, it is not found.

Bone metastases often cause diseases such as breast cancer, prostate cancer, lung cancer, kidney cancer or colon cancer.

Vertebral Compression Fractures

This type of fracture occurs due to excessive force acting on the body of the vertebra. However, this form is most common in the elderly.

Causes are osteoporosis, an accident or an oncological condition.

The weakened bone tissue is compressed, which reduces the height of the vertebra. In addition to back pain, there is also a reduction in body height.

Whiplash Injury 

This is a specific type of cervical spine injury. In whiplash injuries, it is hyperextension and hyperflexion of the neck.

Hyperextension = moving rearward and hyper-extending the neck. 
Hyperflexion = hyperflexing the neck forward. 

The mechanism of the injury is based on the rapid movement of the head backwards or forwards. The neck is excessively bent, which causes tension in the spinal cord in the spinal canals.

The spinal cord is mechanically compressed against the vertebrae, resulting in contusion and circulatory disorders, i.e. ischemia. The formation of a hematoma, ie blood discharge, and subsequent spinal cord compression is at risk.

Other expressions used to describe this condition:

• whiplash injury - the movement resembles a whip swing
• nadmerné zrýchlenie - excessive acceleration = hyperacceleration injury of the cervical spine
• cervical acceleration–deceleration

This type of neck injury results due to: 
traffic accidents, 
horse riding,
sports activities, such as contact sports, hockey, adrenaline sports, 
falling on and getting hit in the face and chin,
including physical attacks.

Note: 
In young children, this type of injury may also occur if violently shaken = Shaken Impact Syndrome
also called Shaken baby syndrome - SBS = it is often an case of child abuse and neglect.
There is a risk of injury to the brain and spine at the same time.

The main symptoms of a whiplash injury are:

• neck pain
• movements make the pain worse
• restriction of neck mobility
• headaches
• pain radiating to the shoulders and upper limbs
• tingling, pin and needles in the limbs
• numbness
• nausea 
• dizziness
• including:
  • double vision
  • high-pitched sounds in the ears - tinnitus
  • limb weakness
  • inability to concentrate and memory loss

A specific type of spinal cord injury is:
hangman's fracture. 
A fracture of both pedicles, or partes interarticulares, of the axis vertebra (C2). 

The overall picture of the symptoms depends on the location and extent of the spinal cord injury. The affected person complains of pain and other health issues.

The symptoms immediately resulting from the injury are acute. They can be observed immediately after the injury and the victim reports subjective difficulties.

However, in some cases, deterioration occurs even after hours or days.

Loss of consciousness of the injured changes the situation.

In this case, spinal damage must be suspected.
The sufferer is treated

as if the injury were to the spine and the spinal cord.

Similarly, if the person is under the influence of narcotics, drugs, alcohol or medication and the risk mechanism is known or the injury is observable.

Interestingly, a quarter of injuries are caused by the influence of alcohol.

The affected person may complain of general symptoms such as:

• back pain
  • neck pain, chest pain, stomach pain, low back pain
• limited mobility of the injured spine
• pronounced sensitivity and pain to touch in a given place
• tingling, pins and needles, other paresthesias
• impaired sensation in the limbs, numbness
• impaired muscle strength
• loss of muscle control, muscle weakness
• loss of sphincter control, bladder and bowel dysfunction
  • urinary incontinence
  • fecal incontinence
• difficulty breathing
• spinal deformity
• priapism - a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended

There are two types of spinal cord injury: incomplete, or partial, and complete injuries. The symptoms depend on the type of injury.

Spinal cord injury is a dynamic process.

A number of changes occur inside the injury. A partial injury may become a complete injury.

The extent of spinal cord injury thus extends one or two segments above the site of injury. Symptoms develop based on the height of the lesion, i.e. in the spine or the spinal nerves.

Table: Spinal Cord Injuries

Injury By Spine Segment

Certain symptoms are present depending on the extent of the spinal cord and spine injury. Examples are given in the table.

Table: Symptoms By Injury to Individual Spinal Segments

In spinal cord injuries, two conditions are reported, namely spinal shock and neurogenic shock.

In short...

1.

Spinal shock is a transient condition that occurs immediately after a spinal cord injury. Disorder of sensory, motor functions and autonomic vegetative innervation occurs. It recedes over time. Recently, the difficulties resulting from the damage present persist.

Sensory functions = skin sensitivity. 
Motor functions = mobility. 
Vegetative innervation = autonomic nervous system,  
innervating, for example, smooth muscles, digestive organs, blood vessels and glands.

2.

Neurogenic shock is described as a triad of hemodynamic changes, namely: 
1. hypotension (low blood pressure),
2. bradycardia (a slow resting heart rate)
a
3. peripheral vasodilation (dilation of the vascular bed on the periphery, i.e. outside the heart and brain).

This type of shock occurs acutely when injured above the spinal segment Th6.

Spinal cord injuries can also be described as...

Spinal Cord Syndromes

In a sudden transverse spinal lesion together with spinal shock.

There are also progressive lesions, for example in cancer or degenerative diseases. In this case, the changes are slow.

There are also pains, weak or spastic paralysis, impaired muscle strength and sensitivity, impaired emptying (sphincters - sphincter disorders) and trophic skin changes.

Spinal shock below the level of the damaged spinal cord.

There is complete loss of mobility and sensitivity and there is no pain is present. Fecal and urinary incontinence (urinary incontinence) is present due to a discharge disorder. Early pressure ulcer formation is also attributed to skin changes.

Spinal shock may not always be transverse, i.e. transverse spinal cord injury.

Over time, the spinal shock begins to subside, after about 2-3 weeks. Subsequently, some neurological abilities and natural reflexes return. Other symptoms depend on the extent and location of the spinal cord injury.

Rehabilitation is very important at each stage.

Transient neurologic syndrome

The term refers to a reversible, or curable, disability, not a permanent one. It is characterized by impaired motor skills, mobility, sensitivity, and sphincter control.

It is manifested by paresthesias, especially in the limbs, e.g. a burning sensation in the hands.
After a while, the patient is able to walk for a few minutes or hours.

Persistence of loss of motor and sensory functions for more than 24 hours
=
high probability of permanent disability. 

It often occurs in sports activities and contact sports with a higher degree of physical activity. Although the cause is unknown, the risk of repeated overload is assumed, which increases the presence of a narrowed spinal canal.

Weak Peripheral Paralysis

It occurs when the front roots, and thus the spinal motor circuit, are damaged. In addition to injury, they can also be caused by a tumour, a damaged plaque, vascular and other neurological diseases.

It manifests as:

• weakening, reduction or loss of muscle strength
• reduction to loss of muscle mobility
• reflex disorder
• reduced muscle tension, weakening to muscle atrophy at a later stage
• fasciculations - muscle twitches
• skin changes
• skin sensitization disorder

Central Spastic Paresis

Similarly, they arise not only as a result of an injury, but also, for example, in a stroke. The injury also involves transverse spinal cord injury and disturbance of the neural tracts.

Transverse spinal cord lesion syndrome = transverse spinal cord injury

The symptoms are:

• paralysis on the opposite side of the body such as damage - contralateral paralysis
  • in an event affecting one half of the brain, the difficulties manifest themselves on the other side of the body
• diminished or loss of muscle strength
• diminished or loss of mobility
• increased tonus - spastic muscles - hypertension
• Pyramidal tract pathology - hyperreflexia

Moreover...

There is also a mixed weak spastic form presenting with muscle twitching, paresis, plegia and hyper-reflexes (presence of pathological reflexes).

Diminished sensitivity is a result of damaged posterior spinal roots.

Diagnosis of the extent of spinal cord injury alone cannot be performed in the field. This means that it only occurs in a hospital environment.

Of course, the initial and secondary on-site examination is important. Medical history and basic clinical and entry neurological examinations are performed.

If the patient is conscious, he or she describes the signs and symptoms, pain, tingling in the limbs, muscle weakness or loss of sensitivity.

Immediately after transport with first aid, imaging tests are done.

Monitoring vital signs is important on site and during transport to the hospital.

Blood pressure, pulse and respiratory rate, and blood oxygen saturation are checked regularly for early shock detection.

CT is the method of choice. MRI may be added later. Alternatively, an X-ray done in the initial phase with a non-serious mechanism suffices.

Spinal injuries are treated by traumatologists and neurosurgeons.

In severe polytrauma, several injuries are present. What can be related to the cooperation of several medical disciplines, from anesthesiology, surgery and others.

Polytrauma =  the condition of a person who has been subjected to multiple traumatic injuries with at least one of them being life-threatening.

It is also possible to supplement a laboratory blood test at the hospital, perform ECG monitoring, possibly EMG, and an examination of the neuromuscular system and evoked potentials.

Spinal injuries can have a different clinical course. Immediately after the injury, the person does not have to complain of any difficulties, but on the contrary, he may have fully developed quadriplegia and severe breathing.

Clinical sign, symptom = objective manifestation that is visible, measurable, observable.
Skin colour, cough, external injury, blood pressure, pulse.
Subjective sensation = cannot be directly monitored or measured, signs and symptoms felt by the affected person.
Pain, difficulty breathing, weakness, tiredness, palpitations.

However, the absence of symptoms is not critical.

When providing first aid and pre-hospital care, it is necessary to evaluate the mechanism of the injury and treat the affected person as if it were a case of spinal cord injury with possible spinal cord injury.

The circumstances of the accident can be such that there is no visible injury, such as a fall or impact from height impacting the lower limbs.

In other cases, the external injury is present and visible. These may be superficial abrasions, subcutaneous hematoma, i.e. blood suffusion under the skin, swelling and bleeding.

In some cases, there may be palpable deformations, protrusions and contusions of the spine.

More severe spinal injury with spinal cord injury has both objective and subjective symptoms regarding its level and extent.

Please note that...

Immediately following the accident, the injury is not always fully noticeable and visible. A spinal cord injury is a dynamic process that takes time to develop and manifest.

In the next 4 hours, there will be a cascade of biochemical changes involving enzymes. These negatively affect the resulting pattern of spinal cord injury.

Fully developed symptomatology (set of symptoms) may appear after some time. In the end, the damage is usually complete, because the extent of the injury extends one or two segments above the height of the injury.

Time frame = hours or days.