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In Depth: Spinal Injuries

Spinal Injury

Whether they happen as a result of an automobile accident, a workplace injury or because of a defective product, spinal injuries invoke fear because at their worst, they give rise to images of wheelchairs and permanent, life-changing paralysis.

While the most severe spinal injuries can be life altering, there are many ways that the spine can be injured that are serious, but not paralyzing. Because spinal injuries are actually more common than most people think, it is worthwhile to understand the anatomy of the spine and how the spine can be injured.

Anatomy of the Spine

The basic structures that make up the spine include the spinal cord, the nerve roots that exit the cord and travel to all parts of the body, the vertebra that protect the cord, the ligaments that support the spine and the intervertebral discs between most of the vertebra.

The spinal cord is a long bundle of nerve tissue that extends from the base of the brain, down the back, through the spinal column. The spinal cord is made up of motor and sensory nerve cells called neurons. The motor nerves transmit commands from the brain to the muscles that allow us to control movement. The sensory nerves transmit information about what we feel, like temperature and pain.

The vertebrae are a series of interconnected bones that protect the spine. The vertebrae fit together into a long series of joints. Each individual joint has not much movement, but, taken altogether, the range of movement of the spine as a whole is considerable, allowing a person to bend and twist.

The spine is divided into five basic regions: seven cervical vertebras make up the neck (C1-C7); twelve thoracic vertebras (T1-T12) make up the upper and mid back; five lumbar vertebras (L1-L5) that make up the low back; the sacrum, which has five segments (S1-S5) and coccyx (tailbone). There are small canals on each side of the vertebra called intervertebral foramen through which the nerve roots that service the body branch off of the spinal cord.

In between almost every vertebra is a disc that acts like a shock absorber. Discs are a bit like a jelly donut with a gel-like center called the nucleus pulposus and a stronger, fibrous outer covering called the annulus fibrosus.

The spine integrity is maintained by three ligaments running the length of the spinal column: the anterior longitudinal ligament; the posterior longitudinal ligament; and the ligamentum flavum. There are smaller ligaments connecting individual adjoining joints (facets) between vertebrae.

Spinal Injuries

The spinal vertebra can be fractured as a result of trauma. Vertebral fractures can be stable or unstable. Vertebral fractures may be referred to as compression fractures or burst fractures. Unstable vertebral fractures put the spinal cord at risk for injury. Additionally, bleeding can occur around the spinal cord after vertebral fracture which can put the spinal cord at risk. Each fracture must be evaluated, whether compression fracture, or burst fracture, to determine whether the spinal cord is at risk. Additionally, severe spinal ligamentous injury can also cause the spine to become unstable, putting the spinal cord at risk.

There are other traumatic spinal injuries that do not involve a fracture. Musculoskeletal strain, also known as whiplash, results when the soft tissues of the muscles, ligaments and tendons are stretched beyond their limits resulting in pain, spasm and swelling.

Another common spinal injury is traumatic damage to an intervertebral disc. Disc injuries are often grouped into four categories: degeneration, protrusion, herniation and fragmentation.

Disc degeneration causes a bulge or a loss of disc height where the annular fibers remain intact. A protrusion, sometimes known as a prolapsed, is a bulge where some annular fibers are lost but others remain intact. A herniation, sometimes known as an extrusion, results from a loss of annular fibers in a manner that allows the jelly-like disc nucleus to extrude through the annular tear. Finally, fragmentation, sometimes known as sequestration, occurs when either or both of the annulus or the nucleus separates from disc.

Any of these four categories of disc injury can result in compression or irritation of a nerve root or of the spinal cord itself. Compression of the cord is called myelopathy. A serious form of myelopathy is called Cauda Equina Syndrome, which is caused by a large central disc herniation that compresses the lower spinal cord. Symptoms of cauda equina syndrome include loss of bladder and bowel control. Radiculopathy is nerve pain caused by compression or irritation of a nerve root. It causes pain, numbness, and/or tingling in the areas enervated by the damaged nerve, which is known as a dermatome. Sciatica is radiculopathy involving the sciatic nerve and can be caused by a herniation at L5/S1.

Many disc herniations--some studies show as high as 50%--improve with time and without invasive treatment. In the case of disc injuries that result in intractable pain; severe or worsening neurological deficits, or the lack symptomatic relief after 4 to 6 weeks, surgery may be indicated.

The most basic surgical procedure for spinal disc injuries is called a laminectomy and discectomy. In this procedure, the surgeon makes a small incision over the injured disc, removes a piece of bone, called the lamina, from the vertebra to expose the foramen, and then removes the disc material that is irritating the nerve.

If the disc is damaged beyond the point of repair, the injured person may undergo a spinal fusion, where the surgeon will remove the disc entirely and fuse together the vertebrae above and below the removed disc using a metal plate, screws and a bone graft.

Any and all of these structures (spinal cord, vertebrae, ligaments, intervertebral discs, and cauda equina) can be injured as a result of trauma, but by far the most serious spinal injury is damage to the cord itself, which can cause permanent, irreversible paralysis. Approximately 50% of all spinal cord injuries are caused by motor vehicle accidents, 20% caused by falls and most of the remainder by violence or sports injuries.

How Faraci Lange Can Help

Although this may seem complicated, the attorneys, nurses and staff at Faraci Lange have worked on hundreds of cases involving spinal injuries from the most common to the most devastating. Our team has the wisdom and experience to represent people who have sustained spinal injuries of all types. If you or someone you love have sustained a spinal injury in an accident, contact Faraci Lange for a free consultation.

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