Whilst rare, a person with a suspected spinal injury should be treated carefully to avoid causing or worsening any spinal cord injury.
Read on to find out when to suspect a significant spinal injury and what to do.
Introduction
The spine is the central element of our skeleton. It's made up of lots of vertebrae (small bones), separated by disks.
Running through the centre of the vertebrae is the spinal cord. This bundle of nerve cells connects the brain to our muscles, sensory apparatus and organs. It's essential for life.
Individual nerve cells leave and enter the spinal cord between vertebrae where they serve the muscles and organs in specific regions of the body.
Nerve cells are both complex and fragile.
The axon part of a nerve cell can be up to a meter long and is often unable to regenerate after injury. This is why spinal injuries can be so important and why many first aiders worry about them.
Spinal CORD injury can be life-changing
It's actually the spinal cord injury (SCI) that we should worry about. Fracturing the bones of the spine is not a problem unless it interferes with the spinal cord.
This usually happens when there's an 'unstable' spinal fracture that when moved causes damage to the spinal cord.
Risk Factors for SCI
In recent decades, UK Ambulance Services and first aiders have been overly cautious about spinal cord injuries (SCIs) due to the potential for further life-changing injuries. As a result, many people have been immobilised unnecessarily.
In fact, there are only about 1200 SCIs in the UK every year. We now know that the majority of these will be due to significant physical trauma.
The main mechanisms include:
Vehicles
Motorcyclists
Vehicle has rolled over
Seatbelts not worn
Ejected from vehicle
Struck by vehicle
Falls
Significant height
From standing in older people or those with brittle bones
Sports
Diving into shallow water
Horse riding
Mountain biking
Rugby (often scrum collapse)
Gymnastics and trampolining
Also, if someone has been subjected to significant force, or their spine (especially neck) has been bent outside the normal range of motion, you should suspect spinal injury that could cause SCI.
Signs and Symptoms
As well as the mechanism suggesting a significant spinal injury, there may also be signs and symptoms of damage that has already been done.
However, if there's a mechanism but no signs and symptoms, you should still assume they have a significant spinal injury.
Spinal Cord Injury
Since the nerves in the spinal cord control movement and sensation, the person may have:
Loss of movement
Altered sensation (burning, tingling)
Loss of sensation (numbness)
Pain in the spine (central boney part, not the muscles next to the spine)
Spinal Shock
It's worth noting that there's something called Spinal shock. This is a temporary response to injury that may exhibit symptoms typically associated with a permanent disability.
This means that just because a person has lost movement or sensation, this will not necessarily affect them for the rest of their life.
Neurogenic Shock
The person may also be experiencing clinical (neurogenic) shock due to the brain no longer being able to properly control the respiratory and/or cardiovascular systems.
Signs and symptoms of shock include:
Fast breathing and pulse
Pale, cold, clammy skin
Nausea and/or vomiting
Blue (cyanosed) lips
Confusion or loss of consciousness
You can find out more in this blog post about clinical shock.
Management
If you suspect someone may have a significant spinal injury, the management is extremely simple...
Minimise movement
This simple technique will ensure that no further damage is done, should someone have an unstable spinal fracture.
If someone is conscious and you're on your own, it may be easiest to simply ask them not to move while you're getting help and dealing with other injuries, such as bleeding.
If possible, you should get someone to provide 'Manual In-line Stabilisation' (MILS). This simply means holding their head gently to remind them to keep it still.
However, it should be remembered that it may be necessary to move someone.
You may need to move them due to an immediate danger (such as a fire) or to access them to be able to give first aid. In these cases, you should move someone, but try to keep their neck and spine in line as much as possible and minimise any movement, particularly of their neck.
You may also need to move them to manage their airway if they are unconscious. Techniques such as a 'jaw thrust' may be used instead of a 'head-tilt chin lift' and 'log rolling' may help if they are sick. Putting someone into the 'spinal recovery position' may also be helpful...
Raising the underneath arm helps to keep their neck straight.
Read this blog post to learn more about dealing with unconscious patients.
Summary
It's very unlikely that someone has sustained an unstable spinal injury that could cause or worsen a spinal cord injury.
However, if someone has been involved in an incident involving a lot of energy or forces to the neck and spine, or if they have any relevant signs and symptoms, minimise movement.
Remember that you should still move them if you need to, but minimise movement of the neck and spine when you do.
If you'd like to find out more about how to recognise and manage someone with a potential spinal injury, just get in touch to discuss and arrange a course for your group.
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