Spinal injuries

Injuries to the neck and back are most commonly caused by traffic accidents. The areas most often damaged are the muscles of the back and neck, the bones of the spine (vertebrae) and the ligaments that hold the bones together.


Injuries to the spine may also damage the spinal cord, which lies in a narrow canal in the vertebrae and carries all the major nerve pathways connecting the limbs and trunk to and from the brain. Damage to the spinal cord may cause numbness and weakness in part of the body. If damage is severe, it can result in paralysis, which may be permanent and even life-threatening. Spinal injuries occur more commonly in young men, often as a result of risk-taking behaviour or playing contact sports.

What are the types?

The most common type of spinal injury is whiplash, in which the ligaments and muscles of the neck are damaged. The spinal cord is not usually affected by this type of injury. Whiplash is caused by sudden, extreme bending of the spine when the neck is “whipped” back, usually as the result of a road accident.

A spinal injury may dislocate or fracture one or more of the vertebrae. The vertebrae may be damaged by an impact, such as being hit by a car, or by compression, usually due to a fall from a considerable height. The spinal cord may be damaged by dislocated or broken vertebrae or by a penetrating injury.

What are the symptoms?

Symptoms of a spinal injury depend on the type and severity of the damage and on which part is injured. A whiplash injury may lead to one or more of the following symptoms:

- Headache.
- Neck pain and stiffness.
- Swelling of the affected area.
- Shoulder pain.

Displacement or damage to vertebrae, including compression of a disc, may cause pain and inflammation. If there is damage to the spinal cord, symptoms occur in other parts of the body. These symptoms may include:

- Loss of sensation.
- Weakness.
- Inability to move the affected part.
- Problems with control of the bladder and bowels.

The areas of the body that are affected by symptoms depend on which part of the spinal cord has been damaged. The higher up the spinal cord the damage has occurred, the more parts of the body will be affected. For example, damage to the mid-chest area of the spine may cause weakness and numbness in the legs but will not affect the arms. If the spinal cord is severely damaged in the neck area, there may be total paralysis of all four limbs (quadriplegia), the trunk and muscles that control breathing and death may result.


Anyone who has a suspected neck or spinal injury must not be moved without medical supervision. Emergency first-aid measures should be carried out and medical help sought at one.

How are they diagnosed?

Once the injured person is in hospital, a full neurological assessment will be performed. This will include measuring the person’s responses to different kinds of stimuli, which helps to assess whether the spinal cord has been damaged. If there is damage, CT scanning or MRI may be used to determine its nature and extent. If a fracture of the vertebrae is suspected, X-rays of the spine may be taken.

What is the treatment?

If there is ligament and muscle damage, but the vertebrae are undamaged and unlikely to become displaced, bed rest and regular monitoring will probably be the only treatments that are needed. Nonsteroidal anti-inflammatory drugs may be used to relieve pain and swelling of the tissues, and physiotherapy may be required to strengthen the damaged muscles. If the injury has caused vertebrae to become dislocated or damaged, the affected bones will need to be stabilized. Surgery may be carried out to realign damaged vertebrae and prevent possible damage to the spinal cord. People who have irreversible damage to the spinal cord may be paralysed. Sometimes, early treatment with drugs reduces inflammation and limits the extent of the damage. Long-term physiotherapy is necessary to maintain muscle strength.

What is the prognosis?

Recovery from a spinal injury involving only muscles and ligaments is likely to take 4-6 weeks. Fractures usually heal in 6-8 weeks. If the spine is stable and there is no damage to the spinal cord, the person usually makes a complete recovery. When paralysis occurs, a long period of rehabilitation is needed. If there is no improvement after 6 months, the paralysis is likely to be permanent.