During accidents on public roads, the systematic search for trauma to the spinal cord must be a priority for treatment within 3 to 6 hours. The spine is made up of hollow bones, the vertebrae (where the spinal cord passes), which transmit nerve impulses from the brain to the limbs and various organs of the body. Trauma to the spine is common and fortunately is only complicated in a few cases of neurological disorders. Neurological disorders are the consequence of an accident that will transform a whole life. All four limbs (quadriplegia) or the lower limbs (paraplegia) may be paralyzed. Fractures above the fifth cervical vertebra can cause ventilatory disturbances through damage to the phrenic nerve and lead to death from asphyxiation. All fractured levels from the head to the pelvis can be complicated by sphincter and sexual disorders.
Spine Injury – Act Quickly
During the fracture, the spinal cord can be compressed by a bone fragment or by the displacement of the spine made unstable by the trauma. The drop in blood pressure contributes to the worsening of the phenomenon which leads to ischemia (deprivation of blood as in a heart attack) and necrosis (death) of the nervous structure. At this point, there is no more recovery possible. We must therefore act quickly, very quickly so as not to come to this.
We must also do well so as not to make things worse. After observing a trauma to the spine with neurological disorders, it is necessary to:
- Take care of the injured person by mobilizing his column en bloc and immobilizing him during transport (collar-neck brace, shell mattress)
- Make sure good blood pressure (infusion) and effective ventilation (resuscitation)
- Act quickly: refer the injured person to the nearest specialized center where the spine specialist can start the appropriate treatment as quickly as possible
- Diagnosis to confirm the neurological damage with a scanner, which shows the fracture and its repercussions on the spinal canal.
- Operate immediately after diagnosis.
Intervening Surgically Before the 6th Hour is Optimal
In case of a spine injury, a race against time should be committed as intervening surgically before the 6th hour is optimal. Surgery frees the marrow from any compression, reduces strain on the spine, and fixes it. This fixation by screws and rods will prevent micro-movements and destructive process generated by the trauma. Therefore, operating quickly for neurological complications makes perfect sense.
On the other hand, if recovery is not possible (which nobody knows), there will be no regrets in doing right away what you would have done later. In polytrauma patients, it is obviously necessary to operate on the vital lesions first. Stopping a bleeding and restoring speedy blood flow helps protect the marrow from its enemy, ischemia. This scenario is frequent in the young where the vertebral trauma is often related to an accident with high kinetic energy (motorcycle, car, extreme sport, suicide…).
Spine fractures in general, fractures complicated by neurological disorders in particular, are not yet always and everywhere taken care of by specialized teams experienced in this surgery. We must plead for the expert treatment of the patients of a spinal cord injury. It is important to do it quickly and well because afterwards it is too late.
It is important today to get the message across any neurological complication after a fracture of the spine may not recover; but if the care is fast and efficient, some will be able to. No regrets will tarnish this race against time where there is no second chance.