Spinal column injuries in adults: Definitions, mechanisms, and radiographs
- Amy Kaji, MD, PhD
Amy Kaji, MD, PhD
- Associate Professor of Emergency Medicine
- David Geffen School of Medicine at UCLA
- Robert S Hockberger, MD, FACEP
Robert S Hockberger, MD, FACEP
- Section Editor — Adult Signs and Symptoms
- Emeritus Professor of Medicine
- David Geffen School of Medicine at UCLA
- Section Editor
- Maria E Moreira, MD
Maria E Moreira, MD
- Section Editor — Adult Trauma
- Associate Professor, Department of Emergency Medicine
- University of Colorado Denver School of Medicine
- Residency Program Director
- Denver Health Residency in Emergency Medicine
- Deputy Editors
- Jonathan Grayzel, MD, FAAEM
Jonathan Grayzel, MD, FAAEM
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Assistant Professor of Emergency Medicine
- University of Massachusetts Medical School
- Susanna I Lee, MD, PhD
Susanna I Lee, MD, PhD
- Deputy Editor — Radiology
- Associate Professor of Radiology
- Harvard Medical School
- Massachusetts General Hospital
This topic review describes injuries to the cervical, thoracic, and lumbosacral spinal column, including fractures, dislocations, and subluxations of the vertebrae, and injuries to the spinal ligaments. The importance of recognizing and managing injuries to the spinal column is underscored by their association with spinal cord injury.
The management of spinal column injuries and other issues related to spinal cord injury are discussed elsewhere. (See "Evaluation and acute management of cervical spinal column injuries in adults" and "Acute traumatic spinal cord injury" and "Anatomy and localization of spinal cord disorders" and "Evaluation of cervical spine injuries in children and adolescents" and "Overview of cervical spinal cord and cervical peripheral nerve injuries in the child or adolescent athlete".)
Among patients included in a large trauma registry, approximately 3 percent of those with blunt trauma sustain a spinal column injury, such as spinal fracture or dislocation, and 1 percent sustains a spinal cord injury . Spinal column injury rates reported in other studies range from 2 to 6 percent . The incidence is likely to be significantly higher in patients with head trauma and those who are unconscious at presentation. Fracture of the thoracolumbar spine, including spinous and transverse process fractures, may occur in as many as 8 to 15 percent of blunt trauma patients cared for at major trauma centers . Additional noncontiguous spine fractures are common in patients diagnosed with a spine fracture following high-energy blunt trauma [4,5]. A review of over 83,000 patients from the United States National Trauma Data Bank diagnosed with a spine fracture reported that 19 percent sustained a noncontiguous spine fracture.
A systematic review of 13 international studies found great variation (up to a threefold difference) in the rate of spinal column injury among nations, particularly between developed and developing nations [6,7]. Most studies demonstrate a bimodal age distribution where the first peak is found in young adults between 15 and 29 years of age and a second peak in adults older than 65 years of age. Mortality is significantly higher in elder patients . Spinal column injuries are more common in males. (See "Geriatric trauma: Initial evaluation and management".)
Note that statistics from trauma registries can be incomplete and inaccurate, depending on the inclusion criteria, and may underestimate the number of patients with spinal column injury. As examples, victims who die at the accident scene and patients whose neurologic deficits rapidly improve are often not included.
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- MECHANISMS OF INJURY
- CERVICAL SPINAL COLUMN INJURY
- Cervical spinal column injury classification
- Atlanto-occipital dislocation
- Atlanto-axial dislocation
- C1 (Atlas) fractures
- - Burst (Jefferson)
- - Posterior arch
- C2 (Axis) pedicle fractures
- - Odontoid fractures
- Anterior wedge
- Flexion teardrop
- Extension teardrop
- Spinous process fractures
- Burst fractures
- Laminar fractures
- Facet dislocations
- - Bilateral
- - Unilateral
- Ligamentous injuries and SCIWORA
- THORACIC AND LUMBAR (TL) SPINAL COLUMN INJURY
- TL spinal column injury classification
- Compression fractures
- Burst fractures
- Flexion-distraction (lap belt) injuries
- Translational spinal column injury
- Other TL fracture patterns
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS