Overview

Spine and spinal cord trauma represent potentially devastating injuries that can result in permanent neurological deficits and significant disability. The spinal column consists of 33 vertebrae (7 cervical, 12 thoracic, 5 lumbar, 5 sacral fused into the sacrum, and 4 coccygeal fused into the coccyx) that protect the spinal cord, support the body's weight, and allow for movement. The spinal cord is a cylindrical structure of neural tissue that extends from the foramen magnum to the L1-L2 vertebral level, where it terminates as the conus medullaris. Below this level, the lumbar and sacral nerve roots continue as the cauda equina. The spinal cord is protected by the vertebral column, meninges (dura mater, arachnoid, and pia mater), and cerebrospinal fluid. Spinal cord injury (SCI) can result from direct trauma to the cord or from secondary injury due to compression, ischemia, or inflammation. The consequences of SCI depend on the level and completeness of the injury. Complete injuries result in total loss of sensory and motor function below the level of injury, while incomplete injuries spare some function. Epidemiology: Spinal cord injuries affect approximately 17,000 people annually in the United States, with a prevalence of approximately 294,000 persons living with SCI. The most common causes include motor vehicle collisions, falls, violence (particularly gunshot wounds), and sports injuries. The majority of patients are male (78%), with a bimodal age distribution peaking in young adults (16-30 years) and older adults (>60 years). The economic impact of SCI is substantial, with lifetime costs ranging from $1.5 million to $4.8 million per patient, depending on the level and severity of injury. Beyond the financial burden, SCI has profound effects on quality of life, independence, and psychological well-being. Clinical Scenario: A 22-year-old male is brought to the emergency department after diving into shallow water at a lake. He is immobilized on a backboard with a cervical collar in place. He reports neck pain and inability to move his legs. On examination, he has no motor function or sensation below the nipple line. This presentation is concerning for a complete cervical spinal cord injury, requiring immediate evaluation and management to prevent further neurological deterioration.

Key Points

• The spinal column consists of 33 vertebrae that protect the spinal cord, support body weight, and allow movement
• The spinal cord extends from the foramen magnum to the L1-L2 vertebral level, terminating as the conus medullaris
• Spinal cord injury can result from direct trauma or secondary injury due to compression, ischemia, or inflammation
• Complete SCI results in total loss of sensory and motor function below the level of injury
• Incomplete SCI spares some sensory or motor function below the level of injury
• Common causes of SCI include motor vehicle collisions, falls, violence, and sports injuries
• The majority of SCI patients are male, with a bimodal age distribution
• SCI has substantial economic and quality-of-life impacts
• Early recognition and appropriate management are essential to prevent secondary injury
• Neurological recovery is limited in complete SCI, emphasizing the importance of prevention

Video

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