Among the most devastating injuries seen in either times of conflict or peacetime are spinal injuries. These are immediately life-changing for the patient, but also for their families.

 

What can be done?
 

The vital management in the acute phase after a spinal injury is to prevent further damage. The neural structures, spinal cord and nerves, may be vulnerable if the spinal column, the bony structures making up the vertebrae, are damaged and rendered unstable. There are commonly other injuries, to the organs, ribs or limbs, which may go unrecognized, if the patient has reduced sensation from damage to the spinal cord. 

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Nursing Care
 

The highest quality nursing care is vital. Prevention of infection, skin damage, airway problems, as a result of the injury lessens the chance of complications and further, potentially long-term problems, for the patient. Bladder problems are very common, when there has been a spinal cord injury, the patient often needing catheterisation to allow bladder emptying. careful attention to hygiene and management of the catheter is vital in reducing the risk of infections. If these occur, the infection can spread up to the kidneys, leading to permanent damage. 

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Physical therapy
 

Looking after patients with spinal injuries requires extensive input form the physiotherapy team. The therapist will work on the chest, to minimise infections, the spine itself, once safe to do so and the muscles below the level of the injury to prevent contractures developing, if these muscles are paralysed, and to rebuild strength in them if they still have a neurological supply. 

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Surgical Care
 

An unstable spine can be "stabilised" surgically. This is commonly performed when the patient's general medical state makes it safe to do so, but can be undertaken as soon as possible after the injury, especially if there is evidence of on-going pressure on the spinal cord, causing neurological damage. Other techniques, using bed rest and traction can be employed, if surgery is not appropriate. 

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It has been shown that early appropriate surgery can give improved results in terms of function for the spinally injured patient:

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Spine (Phila Pa 1976). 2003 Jan 15;28(2):180-5.

Functional outcome in trauma patients with spinal injury.

Akmal M, Trivedi R, Sutcliffe J

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What if surgery has already been done?
 

Operations to stabilise an acutely injured, unstable spine, are complex difficult and should be undertaken only by surgeons experienced in this field. However, often these injuries occur in areas where access to expert spinal surgery is restricted and therefore an operation may be performed as an emergency procedure. Sometimes these operations require further surgical input, even further surgery, to obtain the best result.