Traumatic Lumbar Spine Fractures and Dislocations
Spinal injury from high energy trauma is a feared event for any person. Spinal trauma can lead to fractures of the bony elements of the spine, disruption of the discs and ligaments, and in the most severe cases instability with subluxation or dislocation of the spinal column and the consequent injury to the neural elements.
How is spine trauma treated?
Thankfully there is a wide spectrum of injury patterns and not all fractures require surgery and many times a full recovery can be expected if there is no neural injury. After an injury to the spine the first concern is protection of the nerve structures with first aid measures that support and protect the spine by minimising moving the spine until spinal column stability can be established by careful examination and investigation. Common investigations in spine trauma are X-rays and CT scans which are both very good at assessment of the alignment and integrity of the bones of the spine. CT can exclude instability in 98% of cases of spinal trauma. However where there is concern about the nerves, discs and ligaments then an MRI can add essential detail to diagnosing the full extent of the injury.
Once stability or instability of the spine is established then a management plan can be developed by the treating team. If the stability of the spine is in question then a surgeon trained in assessing the spine will decide if surgery is warranted. In some cases a brace can be an appropriate device to help stabilise the spine while it is healing. Other times a period of bed rest can also be prescribed. However, modern spine surgery techniques can be very effective at stabilising the spine and allow return of mobility and function. In severe cases of spinal trauma surgery is the recommended treatment to avoid complications associated with prolonged bed rest and immobility.
Thankfully injuries in the lumbar spine rarely threaten the spinal cord as it terminates at the L1 level. The cauda equina is made up of the lumbar and sacral nerve roots and supply the legs and control bladder and bowel outlets. Nerve injury in the lumbar spine can variably affect the cauda equina and in general the higher the injury the greater the neurological deficit. If the nerve injury is below L3 then walking with or without aids would be expected. Above L3 then many of the important muscles controlling the legs are too weak to allow independent walking.
Recovery from spine injury and surgery
Patients should not be afraid of surgery to stabilise the spine but should be aware that their injury has potentially serious consequences and surgery aims to reduce the impact of their injury and maximise their long term function. Surgery is also only part of the treatment and recovery and rehabilitation can be prolonged. It is not uncommon for patients to still require treatment for over a year.