Injuries to the spine are common in trauma patients. The morbidity associated with these injuries can be significant and life-changing, and some injuries can be life-threatening. Because polytrauma patients are initially seen in urgent circumstances, many fractures may be overlooked. In addition, the diversity of injury patterns and the potential for neurologic compromise make the evaluation and treatment of spinal trauma complex. Failure to recognize these injuries or to properly manage known injuries can have catastrophic consequences. In this chapter, the epidemiology of injuries to the spinal column, the anatomy, biomechanics, and physiology of the spine and spinal cord, the acute management and evaluation of trauma patients with suspected spinal injury, and the management of specific injuries and situations will be reviewed.
To date, the bulk of the literature on the epidemiology of spinal injury in North America has focused on patients sustaining spinal cord injury (SCI), while the epidemiology concerning patients with spinal column injuries without SCI has been less studied. There is currently only one population-based study that has been conducted on spinal column injuries.1 This 1996 study by Hu et al.1 reviewed spinal injuries within the Canadian province of Manitoba in the early 1980s. More recent studies that have attempted to define the epidemiology of spinal injury have relied on the review of patients with blunt trauma presenting to emergency rooms.2,3 While these are perhaps a less accurate reflection of the true incidence, they provide a useful estimation of the scope of the problem.
In the United States, the incidence of spinal fractures has been estimated to be greater than 50,000 injuries per year. Hu et al.1 reported an annual incidence rate of spinal fractures to be 64 per 100,000 in Manitoba. In the United States, with a population of just over 300 million, this would translate to over 192,000 injuries per year. In patients with blunt trauma, the reported incidence of spinal injury is between 3% and 4% in the cervical spine and approximately 6% in the thoracolumbar spine.2,3 Demographically, young men and elderly women are most commonly involved. Although the incidence of females sustaining spinal injury has increased in recent years, males continue to account for the majority of all patients with injury to the spine (52–70%). The most common mechanism of injury is motor vehicle crashes, followed by falls, acts of violence (gunshots, stab wounds), and sports. In certain urban regions, assaults and gunshot wounds (GSWs) may surpass falls as the principal mechanism of spinal injury (Fig. 23-1).
Causes of SCI since 2005. (Reproduced with permission from National Spinal Injury Statistical Center (NSCISC).)
Data regarding the epidemiology of SCI are much more robust as a result of the vast amount of time, effort, and research that has been undertaken to improve outcomes with ...