Traumatic injury of the spine

Acute injury to the spine is a major cause of morbidity in trauma patients. Of 39.15 million reported injury-related emergency department visits in 2002, 5.1% (1.997 million) were related to the spine.1 The incidence of traumatic spinal cord injury (SCI) alone is estimated to be 11,000 to 14,000 cases per year in the United States, with an estimated annual cost of medical and supportive care exceeding $9.7 billion.2-7 SCI are particularly debilitating; more than 50% of patients with SCI are between 16 and 30 years old.2 In the acute trauma setting, SCI may be missed if appropriate clinical and radiographic tests are not performed. For example, in a 10-year retrospective study, Poonnoose et al. found that among 569 patients with SCI, 9.1% of the diagnoses were missed initially; in 50% of missed cases, mismanagement resulted in worsened neurological status.8,9 The medical and fiscal costs of caring for spine injuries are high, and spinal pathology, especially if undiagnosed, may complicate the prognosis and treatment of the trauma patient. Outcome depends highly on appropriate management, skilled surgical intervention, and management of comorbid conditions. As such, it is important to approach the patient with a potential traumatic injury of the spine with an accurate understanding of potential pathology and stability, to manage the patient appropriately.