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London Clinic 07776 511824
Norwich Clinic 01603 505063

The London Norwich Spine Clinic is based at
Hospital of St Johns & St Elizabeth, St Johns Wood, London
and the Spire Norwich Hospital, Norwich.
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Information for GPs

Your spine is one of the most important and complex parts of your body - keeping it healthy is vital if you want to lead an active and pain free life.

Trauma

Spinal fractures are usually the result of road traffic accidents, falls and sporting activities. The spine can fail anywhere but the mobile segments of the cervical and thoraco-lumbar areas are most vulnerable. Inappropriate treatment can have devastating neurological consequences.

Causes

  • Major injuries such as motor vehicle accidents, falls, industrial accidents, sporting injuries and gunshot wounds
  • Underlying medical conditions such as osteoporosis, tumours and infections may make the spine vulnerable to trauma.

Symptoms

Extent of injury can vary from simple sprain to fracture of the bone. Bleeding and swelling within the cord cause neurological problems.

Symptoms depend on the location and severity of the injury, but can include:

  • Pain
  • Weakness
  • Loss of normal bowel and bladder control
  • Sensory changes
  • Spasticity (increased muscle tone)
  • Breathing difficulties (if the injury is high up in the neck)
  • Numbness, pins and needles, tingling, muscle spasm
  • Paralysis

Diagnosis

  • A thorough history and physical examination should alert the clinician to the severity and location of the injury
  • This is then confirmed with appropriate imaging (X-ray, CT scan or MRI scan)

Treatment options

This begins with pain management and stabilising the injury to prevent further damage.

Braces and orthotics are used to maintain spinal alignment and immobilise the spine during healing.

The actual treatment can vary widely depending on the location and extent of the injury. In many cases, spinal cord injuries require substantial physiotherapy and rehabilitation.

Surgery

Surgery may be required if the spine is unstable or if the patient has a weakness in their limbs which is getting worse. The spine is then stabilised using titanium screws, plates and/or cages.


"Mr N has recovered extremely well and has returned to work. He has some mild weakness in his arm but is otherwise back to normal." Read case studies >

Case studies

Mr H, aged 23

Condition: Fracture of the thoraco-lumbar spine

Treatment: Surgery

Mr Rai's notes

"Mr H had a car accident while driving without wearing a seatbelt. He was thrown 80 yards from the vehicle so was likely to be badly hurt. However, when the ambulance crew arrived, he was able to move his arms and legs and showed no apparent signs of serious spinal injury.

Still, the paramedics were careful in transporting him and once at hospital, x-rays showed a severe fracture dislocation. Most people with such an injury are paralysed so it was truly amazing that Mr H had normal function in his legs.

This is a difficult fracture to correct as there is a high risk of causing paralysis during surgical treatment. Mr H was linked to a spinal cord monitoring system throughout the procedure, which allowed us to check his nerves were not damaged during the operation.

The operation was planned in detail by the surgical team. We placed screws above and below the fracture to act as a scaffold before realigning the spine. We then inserted rods and a titanium cage from the front, creating a strong structure for stability and support.

Mr H was able to leave hospital after 2 weeks and recovered very well, so he is almost back to a normal life. He is an extremely lucky man given he suffered such a severe fracture."

Thoraco-lumbar fracture
Pre-operation
Thoraco-lumbar fracture after surgery
Post-operation

Mr N, aged 18

Condition: Fracture of the cervical spine

Treatment: Surgery

Mr Rai's notes

"As a result of a car accident, Mr N had fractured his pelvis, injured his liver and spleen, broken his cervical spine and injured his spinal cord causing partial paralysis.

A CT and MRI scan showed the fractured bone extending into the spinal canal, as well as bruising and blood around the cord.

It was important to stabilise the fracture to relieve the pressure on the spinal cord, prevent any further injury and allow recovery. Surgery was required to remove the damaged bone before reconstructing the spine using titanium cages and plates.

Mr N has recovered extremely well and has returned to work. He has some mild weakness in his arm but is otherwise back to normal."

Cervical fracture
Before and after surgery