Diagnosis & Treatment Spine Injuries, Fractures & Infections
Diagnosing Spinal Cord InjurySpinal Cord Injury
Spinal cord injuries are most often diagnosed in the emergency room. Symptoms of spinal cord injuries may vary. Doctors will determine the injury's type, location, and severity and assess its effects on sensation and movement. Patients will have numerous tests, including:
- A thorough physical and neurologic examination to see if the injury caused paralysis, pain, numbness, and impaired movement or function.
- Imaging exams such as X-rays, computed tomography (CT) scans, and/or magnetic resonance imaging (MRI) are helpful for showing the bones, discs, and nerves in and around the spine.
Types of spinal cord injuries
Spinal cord injuries are classified as either complete (causing total loss of mobility and function) or incomplete (when only some motor function is lost). Paralysis is classified as either:
- Tetraplegia or quadriplegia: The arms, hands, hips, legs, and pelvic organs are all affected by the injury.
- Paraplegia: Paralysis of all of the trunk, lower limbs, and some organs.
Spinal Cord Injury Treatment Options
When someone has a spinal cord injury, emergency medical personnel immediately stabilize the spine to ensure no further damage occurs. The treatment chosen depends on the injury's type, location, and severity. Spinal cord injury rehabilitation is an essential component of therapy to help patients regain as much function as possible. NewYork-Presbyterian has renowned neuro-ICUs to provide specialized critical care services to people with spinal cord injuries.
Nonsurgical treatment for spinal cord injuries
Immobilization may be recommended in the hospital, especially for cervical spinal cord injuries—using traction with weights to keep the head and neck from moving and help align the spine. The ICU team will make sure the patient's blood pressure remains stable, monitor their heart and lung function, and treat any infections and complications that may arise. Rehabilitation with physical and occupational therapy begins while in the hospital, as soon as the patient is able to participate.
Spinal cord injury surgery
Surgery may be needed to remove fragments of bone, to repair ruptured or herniated discs, or to fuse portions of the spine together for stability. This surgery can be very delicate. Och Spine at NewYork-Presbyterian's expert surgeons have exceptional experience in this area and use the latest technologies to operate safely and effectively, using minimally invasive techniques whenever appropriate. Surgery is followed by rehabilitation with physical and occupational therapy. The ultimate goal is to help patients get back to a place of independence.
Diagnosing Vertebral FracturesVertebral Fracture
If your doctor suspects you may have a spinal fracture, we may perform:
- Medical history to learn about your symptoms.
- Physical exam to assess your range of pain and range of motion.
- Imaging exams such as X-rays, CT, or MRI.
- Bone density testing (dosimetry) to see if you have osteoporosis causing compression fractures.
Vertebral Fracture Treatment Options
If you have one or more fractured vertebrae, your treatment will depend on the type, location, and severity of the fracture.
Nonsurgical treatment for vertebral fractures
Some patients with spinal fractures receive nonsurgical treatments to manage pain and stabilize the spine, such as:
- Rest to allow the fracture to heal.
- Nonsteroidal anti-inflammatory drugs or prescription pain relievers.
- Bracing to stabilize the spine and reduce pain.
- Physical therapy to strengthen the core muscles around the spine and teach more effective ways of moving.
- Medical treatments, such as injections, to boost bone density and prevent future compression fractures.
Surgery for vertebral fractures
Different surgical approaches are available to repair fractured vertebrae, relieve pressure on the spinal cord, restore stability to the spine, and relieve pain.
Treatment of vertebral compression fractures. A balloon kyphoplasty, a tiny balloon is inflated inside the fractured vertebra first to restore its height. The cement is then injected into the expanded space to ensure the bone does not collapse again. Both procedures are performed under X-ray guidance.
Minimally invasive spinal fusion joins affected bones of the spine together with plates and screws, so there is no longer any motion between them. This procedure can be used to repair a fracture and reduce spinal pressure, pain, and nerve damage. Minimally invasive lumbar fusion does not require a large incision and is associated with a fast recovery time. A computerized image guidance system may be used to optimize the placement of screws and avoid injury to delicate nerve tissue.
Decompression surgery. The surgeon may remove the part of a fractured vertebra that is compressing the spinal cord and nearby nerve roots. Pressure is relieved by removing the arched part of the vertebra ("laminectomy") or the main vertebral body ("corpectomy").
Diagnosing Spinal InfectionsSpinal Infection
If you have a spinal infection, it is essential to determine what is causing it so you can receive the best treatment. You may have:
- Physical examination to assess your symptoms.
- Imaging exams such as X-rays, CT scans, or MRI.
- Blood tests to see if your blood counts have changed (such as an elevated white blood cell count indicating infection) and to look for markers of inflammation indicating infection.
- Sometimes a surgical biopsy is performed to remove infected tissue and analyze it to see what is causing the infection.
- Radioisotopic bone scanning—using nuclear imaging to help monitor bone infections.
Spinal Infection Treatment Options
Doctors try to use nonsurgical treatments first to fight a spinal infection, and in many cases, that is all that is needed.
Nonsurgical treatment for spinal infection
Antibiotic or antifungal medications help kill the organisms causing the infection. They may be taken for up to 8 weeks and are usually given intravenously at your home. If the infection has caused a loss of function, physical therapy may be helpful to regain strength and range of motion.
Surgery for spinal infection
People with spinal infections may need surgery if the infection has destroyed bone tissue, caused spinal instability, or impaired sensation or movement. The surgeon may:
- Remove the infected bone.
- Use plates, screws, and cages to stabilize the remaining bone.
- Perform kyphoplasty if the infection causes the collapse of a vertebra.
- Relieve the pressure of an abscess pressing on the spinal cord using laminectomy.
- Treat the infected tissue so it can receive better blood flow and heal faster.
When Is Surgery the Best Option?When is Surgery the Best Option?
Spine specialists reserve surgery for those times when nonsurgical treatments fail to cure a problem. They may also use it in emergencies to reduce the chance of future complications and to prevent further damage, such as:
- Removing bone fragments from an injured spinal cord.
- Stabilizing a spine made unstable by trauma, a fracture, or infection.
- Remove infected tissue that is not getting better with medications and may spread to the bloodstream (sepsis).
A comprehensive evaluation by a spine expert is the best way to learn which treatment plan is best for you.