AANN Core Curriculum, 7th Edition, Ch. 21 Traumatic Spine Injuries: Digital Version-Chapter 21

Chapter 21

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Traumatic spine injuries damage the vertebral column, supporting tissues, spinal cord, or nerve roots. Injury may result from flexion, extension, rotation, axial loading, or penetrating trauma. Primary cord damage can cause immediate loss of motor, sensory, and autonomic function; subsequent ischemia, swelling, and inflammation may worsen injury. Spinal shock causes temporary flaccidity and absent reflexes. Injuries are classified by stability, neurological level, and completeness; sacral sparing distinguishes incomplete from complete injury.<br /><br />About 17,730 new spinal cord injuries (SCIs) occur annually in the United States. Most patients are male; motor vehicle crashes and falls are leading causes. Higher-level and more complete injuries, older age, chronic illness, and associated trauma are linked to worse outcomes.<br /><br />Initial care prioritizes airway, breathing, circulation, spinal motion restriction, and prevention of hypoxia and hypotension. CT is generally used to assess bone injury; MRI helps evaluate the cord and soft tissues. Standardized neurological assessment records motor and sensory function, including sacral function, and should be repeated regularly. Unstable injuries or neurological deterioration may require traction, bracing, decompression, or surgical stabilization. High-dose methylprednisolone is not recommended.<br /><br />Care also addresses respiratory weakness, neurogenic shock, bradycardia, orthostatic hypotension, autonomic dysreflexia, temperature instability, and venous thromboembolism. Prevention and treatment of pneumonia, pressure injuries, bowel and bladder dysfunction, malnutrition, pain, spasticity, and contractures are central to recovery. Rehabilitation may include mobility training, assistive devices, functional electrical stimulation, and individualized bowel and bladder programs.<br /><br />SCI can profoundly affect sexuality, mental health, relationships, independence, and community participation. Nurses support coping and self-efficacy through clear education, psychosocial screening, family and peer support, and coordinated discharge planning that promotes accessible housing, equipment, attendant care, employment, and long-term health.

Keywords

spinal cord injury

traumatic spine injuries

vertebral column

neurological assessment

spinal shock

autonomic dysreflexia

CT scan

MRI

rehabilitation

bowel and bladder dysfunction