Spinal Injury

First aid for a suspected spinal injury

1. Call 911 or your local emergency number.
2. Do not move the person unless they are in danger (fire, traffic, water).
3. Keep the head, neck and back in line. Hold the head still with your hands on either side.
4. Do not remove a helmet unless needed to open the airway.
5. If the person vomits or must be moved, log-roll them with helpers, keeping the spine aligned.
6. If they stop breathing, start CPR while minimizing head movement.

Types of spinal injury

Soft tissue injuries

Muscle and ligament strains and sprains are the most common back and neck injuries. Whiplash is a neck soft-tissue injury from rapid back-and-forth motion. These cause pain and stiffness but no nerve damage and usually improve within weeks.

Disc injuries

A herniated disc can press on a nerve root, causing sciatica or arm pain, numbness and weakness. Large central herniations in the lower back can compress the cauda equina, an emergency.

Vertebral fractures

Neck fractures are covered in detail on fracture of the neck.

Spinal cord injury

Spinal cord injury disrupts signals between the brain and body below the injury.

• Complete injury: no movement or sensation below the injury level
• Incomplete injury: some function preserved, for example central cord syndrome (arms weaker than legs, often in older adults after neck hyperextension) or Brown-Séquard syndrome (weakness on one side, loss of pain sensation on the other)
• Tetraplegia (quadriplegia): injury in the neck, affecting arms, trunk and legs
• Paraplegia: injury in the chest or lower back, affecting legs and trunk

Doctors grade spinal cord injury using the ASIA Impairment Scale from A (complete) to E (normal).

Symptoms

• severe pain in the neck or back
• a visible deformity or step in the spine
• numbness, tingling or burning in the arms, legs or trunk
• weakness or paralysis
• loss of bladder or bowel control
• difficulty breathing (high neck injuries)
• low blood pressure and slow heart rate (neurogenic shock)

Diagnosis

• Neurological examination: strength, sensation and reflexes to determine the level and severity
• CT scan: the main test for fractures after trauma
• MRI: shows the spinal cord, discs, ligaments and bleeding
• X-rays: for follow-up and some low-risk injuries
• Clinical decision rules help decide who needs imaging after neck injury

Treatment

Acute care

• spinal immobilization during transport and assessment
• maintaining blood pressure and oxygen to protect the cord
• breathing support for high cervical injuries
• early surgery to decompress the cord and stabilize unstable fractures
• prevention of blood clots, pressure sores and infections

Fracture care

• stable fractures: pain relief, early mobilization and sometimes a brace
• painful osteoporotic compression fractures: pain relief, bracing, and kyphoplasty or vertebroplasty in selected cases; treatment of osteoporosis to prevent further fractures
• unstable fractures: surgical fixation with rods and screws

Rehabilitation

Rehabilitation begins early and involves physical and occupational therapy, bladder and bowel programs, skin care, mobility aids, psychological support and vocational help. Most recovery after spinal cord injury occurs in the first 6 to 12 months, though some continues for longer.

Complications of spinal cord injury

• breathing problems and pneumonia
• pressure injuries (bedsores)
• urinary tract infections and bladder problems
• blood clots
• chronic pain and spasticity
• autonomic dysreflexia: a sudden, dangerous rise in blood pressure in people with injuries at or above the mid-chest level, triggered by a full bladder or other stimulus below the injury
• depression and anxiety

Prevention

• wear seat belts and use correct child car seats
• never dive head-first into shallow or unknown water
• use correct technique and protective equipment in sports
• reduce fall risk at home, especially for older adults
• treat osteoporosis
• never drive impaired

Frequently asked questions

What are the signs of a spinal injury?

Signs include severe neck or back pain after an injury, numbness, tingling or weakness in the arms or legs, loss of bladder or bowel control, trouble breathing and an unusual position of the head or back. Anyone with these signs after trauma needs emergency care.

What should you do if you suspect a spinal injury?

Call 911 or your local emergency number, keep the person still with the head, neck and back in line, and do not move them unless they are in danger. Do not remove a helmet unless necessary to open the airway.

What is the difference between a spinal injury and a spinal cord injury?

A spinal injury is any damage to the spine, including muscles, ligaments, discs and bones. A spinal cord injury specifically damages the cord or nerves inside the spine, affecting movement, sensation and body functions below the injury.

Can you recover from a spinal cord injury?

Recovery depends on the severity. People with incomplete injuries often regain significant function, mostly in the first 6 to 12 months. Complete injuries have less recovery, but rehabilitation helps people achieve independence and good quality of life.

How long does a spinal fracture take to heal?

Most stable vertebral fractures heal in 8 to 12 weeks. Pain often improves before healing is complete. Unstable fractures repaired with surgery may take several months to fuse, followed by rehabilitation.