Traumatic spinal cord injuries are associated with skeletal and ligamentous as well as intraspinal pathology. The most common Cervical level for spinal cord injury is C5, followed by C6 and then C4. T12 is the most common Thoracic level for spinal cord injury.
Traumatic spinal cord injuries are most commonly secondary to Motor vehicle accidents and gunshot wounds, followed by falls, bicycle accidents, and pedestrian verses auto accidents. Fractures, dislocations, bleeding and swelling can precipitate trauma to the cord. A common misnomer is that the cord is “transected” when injured; however, the spinal cord is rarely physically transected. It may be stated that the cord is “physiologically transected” as it loses it’’s supply of oxygen and glucose as a result of traumatized blood vessels that supply that level of the cord, inducing inflammation and irreversible damage to the central neurons.
Depending on the type of skeletal and intraspinal pathology sustained in a spinal cord injury, an associated neurologic picture will result. This neurologic picture is based on the organization that is present in the spinal cord where motor, sensory and autonomic nerve tracts run systematically from the periphery to the brain. In the majority of traumatic spinal cord injuries, there is skeletal as well as ligamentous damage associated with spinal instability, which necessitates surgical intervention such as fusion. However, there are cases such as gun shot wounds, where mere shock waves can induce enough trauma to the cord to produce swelling and hemorrhage, leaving the vertebral column intact but resulting in a Complete Lesion.