All levels of the spine can be traumatically injured, sometimes with dire consequences.
The most significant complication of spinal trauma is spinal cord injury, and this can occur with injuries to all vertebral levels, down to and including L1. Below L1, neurological injury will be to the caudal equina, or to individual nerve roots.
Spinal trauma may damage vertebrae, discs, facet joints and ligaments, and in high velocity injuries, any or all of these structures may be disrupted.
As a general rule, the neurological injury will be the dominant concern and it is an absolute priority to avoid worsening the primary injury. Primary resuscitation of the injured patient is performed in parallel with acute stabilisation of the injured spine, using an appropriate technique, such as cervical collar, halothoracic traction, cervical traction via skull tongs, TLSO or Jewett brace.
Decisions are then taken as to the longer-term management, including decisions on the type and timing of surgical intervention and placement for longer-term recovery and rehabilitation.
Reconstruction of an unstable deformed spine can be complex, and may require staged surgeries. The underlying principle remains throughout – the reconstruction of a stable spine with decompressed and protected neural elements.
In some circumstances, conservative management of spinal injuries may commence, but be the subject of regular review. In some cases, if the progress proves unsatisfactory, they may evolve to a decision for delayed surgical intervention.