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Spinal column injuries in adults: Definitions, mechanisms, and radiographs

Amy Kaji, MD, PhD
Robert S Hockberger, MD, FACEP
Section Editor
Maria E Moreira, MD
Deputy Editors
Jonathan Grayzel, MD, FAAEM
Susanna I Lee, MD, PhD


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 and acute management 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 [1]. Spinal column injury rates reported in other studies range from 2 to 6 percent [2]. 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 [3]. 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 [8]. 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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Literature review current through: Nov 2017. | This topic last updated: Jul 13, 2016.
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