Acute trauma of the spine Acute spinal trauma refers to any injury to the spinal cord that happens suddenly. It can be a very serious condition, as it can damage the nerves that carry messages between the brain and the rest of the body. This can lead to loss of movement, feeling, and even paralysis. There are many different causes of acute spinal trauma, including: Car accidents Falls Diving accidents Sports injuries Violence the symptoms of acute spinal trauma will vary depending on the severity of the injury and the location of the injury. Some common symptoms include: Pain in the back or neck Weakness or paralysis in the arms or legs Numbness or tingling in the arms or legs Loss of bladder or bowel control Difficulty breathing

1. Acute spinal trauma refers to any
injury to the spinal cord that
happens suddenly. It can be a very
serious condition, as it can damage
the nerves that carry messages
between the brain and the rest of
the body. This can lead to loss of
movement, feeling, and even
paralysis.
acute spinal trauma 1

2. There are many different causes of
acute spinal trauma, including:
•Car accidents
•Falls
•Diving accidents
•Sports injuries
•Violence
acute spinal trauma 2

3. the symptoms of acute spinal
trauma will vary depending on the
severity of the injury and the
location of the injury. Some
common symptoms include:
•Pain in the back or neck
•Weakness or paralysis in the arms
or legs
•Numbness or tingling in the arms
or legs
•Loss of bladder or bowel control
•Difficulty breathing
acute spinal trauma 3

4. Acute trauma
Acute trauma, either in the form of
a direct blow to the spine or the
application of excessive rotational
or compressive force applied to the
spine, can result in injury to
virtually any structure. The
structures most vulnerable to acute
trauma are the annulus fibrosus
of the intervertebral discs, the
endplates of the intervertebral discs
and the vertebral bodies
acute spinal trauma 4

5. diagnose acute spinal trauma:
•Take a medical history and ask
about the patient's symptoms
•Perform a physical examination to
check for signs of nerve damage
•Order imaging tests, such as X-
rays, CT scans, or MRIs, to get a
better look at the spine
acute spinal trauma 5

6. Treatment for acute spinal trauma
will depend on the severity of the
injury. In some cases, treatment
may include:
•Medication to reduce pain and
inflammation
•Surgery to stabilize the spine or
remove damaged tissue
•Rehabilitation to help the patient
regain movement and function
acute spinal trauma 6

7. DISC HERNIATION
When compressive or rotational forces are applied to
the spine, the fibers of the annulus fibrosus can be
stretched beyond their elastic capacity and tear. If
these tears are oriented in a radial fashion, the
nucleus pulposus may migrate through the tear,
causing a protrusion of the disc beyond its natural
borders. This can occur as an acute process in a
healthy disc given sufficient force. Degenerated
discs that already have some degree of annular
tearing, usually in a circumferential pattern, have less
elastic proteoglycans and are less able to withstand
these forces. If there is a disruption of the posterior
longitudinal ligament, nuclear material can extrude
through the annulus, narrowing the diameter of the
neural canal. If the disc herniation protrudes posteriorly in the midline to
narrow the central canal of the spine, compression of the cauda equina or
spinal cord can occur. If the disc protrudes laterally, it can
extend into the lateral foramina, encroaching on the
nerve root.
acute spinal trauma 7

8. COMPRESSION FRACTURE
A direct axial force applied to the
spine, especially in flexion, can
result in a collapse of the vertebral
body. There is a disruption of the
intrinsic bone structure,
followed by edema and healing of
the bone. If severe, these
compression fractures can force
spicules of bone or the entire
vertebral body to move posteriorly,
encroaching on the central canal or
laterally encroaching on the
neuroforamen
acute spinal trauma 8

9. As a result of compression forces,
the endplate of the vertebral body
may collapse, allowing herniation
of the nucleus pulposus into the
vertebral body. This has become
known as a Schmorl’s node
acute spinal trauma 9

10. Bony fractures of the vertebral body are well
visualized on X-ray and the edema associated with
healing is visible on MRI scan. Disc herniation,
however, is not seen on standard X-ray and requires
either an MRI or CT scan to be visualized. Radial
tears and the protrusion of the nucleus into the tear
can be visualized by injecting a radio-opaque dye
into the disc, which can be visualized on X-ray as a
discogram. These changes are more clearly seen on
post-discography CT scanning.
acute spinal trauma 10

11. Electrodiagnostic evaluation is often used to
document injury or encroachment on the nerve roots
or the spinal cord which occurs as a result of disc
Compression fracture
Sagittal TI weighted MR demonstrating decreased
signal intensity in the L3 vertebra, indicative of bone
edema secondary toa compression fracture
Compression fracture Lateral lumbar radiograph in a
patient with osteoporosis and a compression fracture of
L1, with collapse and wedging of the anterior aspect of
the vertebral
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12. Transverse section at the
L5–S1 level showing a disc
herniation centrally
encroaching on the central
canal, causing stenosis.
acute spinal trauma 12

13. One variety of vertebral body and endplate
defect allowing herniation of the nucleus
pulposus into the vertebral body. (a) MRI
TI
weighted image revealed herniation of the
L3–L4 disc into the L3 body, creating a
‘Schmorl's node’ or ‘Geipel hernia’; (b)
the same
patient's T2 weighed image; (c) post-
discogram computed tomography sagittal
reformation demonstrating a ‘Schmorl's
node’
acute spinal trauma 13

14. Axial MRI demonstrating a right-
sided herniated nucleus pulposus
displacing the S1 nerve root (arrow)
a c
b
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15. Demonstration of three different imaging
techniques. (a) MRI
demonstrates a right-sided lateral disc
herniation. The disc
protrusion effaces the dorsal root ganglion
(arrow); (b) nonenhanced computed
tomography of the same patient reveals
increased signal density of the lateral disc
herniation; (c) post discography computed
tomography of the same patient
demonstrates contrast enhancement of the
lateral disc herniation (arrow)
a
c
b
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16. MRI demonstrates a central disc
extrusion at L3–L4. Note that the
posterior longitudinal ligament has
been elevated posteriorly and
separated by the disc herniation.
There is marked central canal
stenosis caused by the disc
herniation
acute spinal trauma 16

17. acute spinal trauma 17
Sagittal T2 weighted MR
image of a lumbar disc
herniation at
L5–SI (a). Axial MR image
demonstrating the L5–SI disc
herniation to the left,
displacing the SI nerve root
(b). The normal appearing
right SI nerve root is seen in
the right subarticular
recess (arrow

18. acute spinal trauma 18
Sagittal T2 weighted MR image
demonstrating a lateral disc
herniation at L4–L5 displacing the
exiting L4 nerve root
(arrow). Note the relationship
between the normal-appearing
nerve roots at L2 and L3 and the
pedicle. The attachment of
the longissimus thoracic pars
lumborum to the transverse
process is seen in the posterior
paraspinal muscle compartment

19. acute spinal trauma 19
Post-discography CT
demonstrating contrast extending
through a confluence of annular
tears into a radial fissure, with
outer annular contrast enhancement
(arrow) a b

20. acute spinal trauma 20
Longitudinal section through the
lumbar spine showing a large disc
herniation at L4–L5 (large arrow).
The posterior facets show
degenerative changes in the form of
irregular surfaces (small arrow).

21. acute spinal trauma 21
Longitudinal section through L2, L3, L4
showing degeneration and disruption of
the intervertebral disc at these levels. The
arrow
points to a fracture in the endplate at the
superior aspect of L3, resulting in
herniation of the nucleus pulposus into the
vertebral body

22. acute spinal trauma 22
Sagittal TI weighted MR
demonstrating decreased signal
intensity in the L3 vertebra,
indicative of bone edema secondary
to a compression fracture

23. acute spinal trauma 23
Lateral lumbar radiograph in a
patient with osteoporosis and a
compression fracture of L1, with
collapse and wedging of the
anterior aspect of the vertebral
body