Spinal Trauma and Spinal Cord Injury (SCI)

Excerpt

The majority of the spinal injuries (60%) affect young healthy males between 15 and 35 years of age with cervical spine injuries to be most common. The main cause for spinal injuries is blunt trauma most commonly due to motor vehicle accidents (48%) followed by falls (21%), and sport injuries (14.6%). Assault and penetrating trauma account for approximately 10–20% of the cases. Injuries to the spinal column and the spinal cord are a major cause of disability, affecting predominately young healthy individuals with important socioeconomic consequences and the costs of lifetime care and rehabilitation exceed one million US dollars per patient excluding financial losses related to wages and productivity. Over the past several decades, the mean age of the spinal cord injured patient has increased which is attributed to a substantially greater proportion of injuries related to falls in the elderly. Cervical spine injuries, of which approximately one-third occur in the craniocervical junction (CCJ) (Riascos et al., Radiographics 35:2121–2134, 2015), account for the majority of the spinal injuries followed by thoracolumbar fractures. Almost half of the spinal injuries result in neurological deficits, often severe and sometimes fatal (Hill and Dean, J Trauma 34:549–554, 1993). Survival is inversely related to the patient’s age, and neurologic level of injury, with lower overall survival for high quadriplegic patients compared to paraplegic injuries. Mortality rate of spinal cord injury during the initial hospitalization is reported to be almost 10% (Pope and Tarlov, Disability in America: toward a national agenda for prevention, National Academy Press, Washington, 1991). Injury to the spinal cord occurs in 10–14% of spinal fractures and dislocations with injuries of the cervical spine being by far the most common cause of neurological deficits (40% of cervical injuries) (Riggins and Kraus, J Trauma 17:126–130, 1997; Castellano and Bocconi, Bull Hosp J Dis Orthop Inst 31:188–198, 1970). The majority of injuries to the spinal cord (85%) occur at the time of trauma, whereas in a minority of cases (5–10%) the spinal cord injury occurs in the immediate post-injury period (Rogers, J Bone Joint Surg 39:341–351, 1957). The imaging methods for evaluating patients with acute spinal trauma have dramatically changed in the last decade especially with the development of thin section multi-detector computed tomography (MDCT) and isotropic datasets that provide high-resolution sagittal and coronal reformats. MDCT allows for a comprehensive assessment of spinal column injury that has largely supplanted radiography except in the pediatric population. Magnetic resonance imaging (MRI) has become the procedure of choice for evaluation of the spinal cord and surrounding soft tissues when a reliable neurologic examination cannot be performed.