Pathology

Stable Fracture

Sometimes the force involved is less, and the vertebra is compressed or crushed on one side……if this is distant from the spinal canal then the spinal cord may be unaffected.

Unstable Fracture

An unstable fracture exists where there is significant disruption of the normal architecture of a vertebra or the ones adjacent to it.

In this case,  the spinal cord is at much greater risk due to the movement of the bones around it, local swelling caused by the injury and interference with the blood supply to the spinal-cord itself.

Types of Fracture

Various types and grades of vertebral fracture can be described

The more severe the grade, the more likely there is to be damage to the spinal cord which runs in the spinal canal.

The fragile spinal cord

The spinal cord itself is divided into anterior (ventral or front) sections and posterior (dorsal) sections at each level as it passes from the brain in the skull on its downward journey.

The anterior segments of the cord give rise to the peripheral motor nerves, whilst the posterior segments carry the peripheral sensory nerves responsible for bringing information back to the brain.

Damage to the cord can occur affecting all these areas, or be biased towards the anterior, posterior or even lateral part of the cord structure. This can provide clues during neurological examination of the injured person as to the precise location of the injury.

Injury can also occur at multiple places and levels of the spinal cord, and damage can progress over time so that the external signs and symptoms also change. This is usually indicative of a poorer prognosis or outcome, and likewise any improvement of symptoms and signs after the injury is usually cause for optimism for a better recovery.

Critically, by applying secondary prevention principles, we can help limit the likelihood of the initial damage progressing by eliminating excessive movement around the damaged vertebrae and the spinal cord when it is most at risk.

Whilst working out where the damage has occurred anatomically is of somevalue,recognising that an injury may have occurred in the first place and appropriate management is the main focus of this course.