Spine Injury (HB)

Spine injury is one of the scariest and most heavily marketed trauma injuries in emergency medicine. The great joke is that the most dreadful outcome—paralysis—happens very infrequently. We as providers can do little about it, including making it worse, assuming we take appropriate precautions.

There is solid scientific evidence that backs up the ability to “clear” a spine in the field. This is one of the Extended Transport Protocols.

Column vs Cord

The spine is made up of two distinct components. The column is the bony support structure that protects the cord (and provides structure to the body and allows us to walk upright).

The spinal cord is the other component and is basically an extension of the brain. It provides the central trunk where the peripheral nervous system attaches. Damage to the cord occurs at the time of injury in the vast majority of cases.

Genuine column injuries are painful enough that the patient will let you know. They will guard the injury and will likely have anxiety around moving.

Low Risk

A low-risk spine injury means there is ONLY column damage. A patient with a low-risk spine is capable of walking out if they want to—there is no additional risk to the cord. The patient complains of pain and or tenderness directly on the spine with no neuro deficit (good motor and sensory in all four extremities). This patient can “walk out” if they are willing.

High Risk

A high-risk spiny injury always includes cord involvement. ANY deficiency to the motor or sensory nerves makes the injury high-risk. This patient should be transported using spine precautions.