Spinal injuries: general aspects

Road traffic accidents and falls from a height are the common causes of most spinal injuries. Standard precautions should be observed in all cases with a suspected spinal injury. The use of a ‘hard cervical collar’ and principles of ‘in-line immobilization’ and ‘log roll’ are mandatory in order to avoid any further injury.

Pain is the most common symptom in a conscious patient. Local bruising, tenderness and a palpable step suggest a significant spinal injury. A complete neurological assessment (Fig. 58(a)(i)(ii)) should be carried out at initial presentation; and repeated at regular intervals. This should include the assessment of the cranial nerves, motor and sensory functions and testing of reflexes (anal, bulbocavernosus, deep tendon reflexes, etc.). Rectal examination is mandatory in order to detect the loss of anal tone, diminution in perianal sensation and presence of blood in the anal canal.

About 10% of patients with a spinal injury at one level may have spinal involvement at a different level. Therefore, a complete clinical and radiological assessment of the entire spine is necessary in all cases.

Standard AP and lateral radiographs should be requested for all spinal injuries irrespective of the level of involvement. However, an open mouth (peg view) is also required to rule out injury to the odontoid process or body of the second cervical vertebrae (axis). Oblique and flexion–extension views are reserved for stable injuries and should be performed only under the supervision of an experienced clinician.