A developing country like India is passing through significant industrialisation and urbanisation leading to a vast change in socioeconomic values. Due to these rapid changes, road traffic accidents (RTAs) have become a public hazard to millions of human lives and their safety. Injuries on the road, at home and work place have increased thus becoming the leading cause of death and morbidity in the world.
Spine injury is a common problem starting from a minor ligamentous injury to a major vertebral fracture and at times leading to devastating spinal cord injury ! These patients with a major spine injury can also have a chest / abdominal trauma in addition. Some do have injuries to blood vessels that surround the spinal vertebral body leading to vascular dissections thereby causing paralysis of the limbs. Apart from road traffic accidents, fall from a height, sports injuries, diving, assault and gun shots can lead to a spine fracture / spinal cord injuries. Spine fractures is yet another important aspect to consider in head injured patient, as an injury to the cervical spine/neck may coexist and should not be missed. Spine injury affects motor movements of the limbs by compression of the spinal cord or nerve roots by a fractured bone chip or a disc leading to quadriplegia/paraplegia.
MANAGEMENT AT THE SITE OF INJURY
The major causes of death in spinal cord injury are aspiration and shock ! Assessment of airway takes precedence, then breathing, then blood circulation & control of bleeding. Any of the following patients should be treated as having spinal cord injury until proven otherwise : 1. All victims of significant trauma 2. Trauma patients with loss of consciousness 3. Minor trauma patients who have pain over the neck or back with tenderness; people with tingling or numbness in the extremities or weakness in the limbs 4. Abnormal abdominal breathing pattern
IMMOBILISATION (with support from paramedics)
A. Log-roll patient for turning B. Place patient on a back-board C. Sandbags on either side of the head with a 3 inch strip of adhesive tape from one side of the back-board to the other across the forehead immobilises the spine, but at the same time allows movement of the jaw and access to airway D. Rigid cervical collar may be used as a supplement E. Maintain blood pressure and adequate oxygenation with the help of paramedics at the arrival of the ambulance. They will also support the patient with CPR (cardio-pulmonary resuscitation) as and when needed, followed by endotracheal intubation.
AT THE HOSPITAL
CT/MRI (Magnetic Resonance Imaging) of the spine is the investigation of choice once the patient is stabilised at the hospital emergency room. Based on the radiological findings and neurological deficits, the patient undergoes either a medical management with analgesics (pain killers) or surgical treatment (decompression and spinal fixation/stabilisation using Titanium implants). In spinal cord injury, treatment with intravenous steroids (Methyl Prednisolone) helps in the recovery of the paralytic limb if the patient arrives at the emergency within the Golden Hour. The outcome and the ultimate prognosis depends on the severity of the injury, the time of initiating treatment (earlier the better) and of course the age factor & and co morbid status of the patient.
(Post operative X Rays showing Spinal Implant – Titanium used for stabilising the Cervical Spine Fracture 6 months back)
Dr. M. J. Arunkumar, M. Ch., DNB Senior Consultant Neurosurgeon Hannah Joseph Hospital Madurai