Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter
XXXIII: Wounds and Injuries of the Spinal Column and Cord
Pathophysiology of Injury to the Spinal Cold
United States Department of Defense
Injury of the spinal cord results from the following mechanisms: (1) compression, (2)
contusion, (3) edema, (4) ischemia and (5) physical transection. Usually an aggregate of
two or more of these mechanisms is responsible. When the injury is complete and the cord
is physically intact, the term physiological transection is used, as opposed to anatomical
transaction where there is physical loss of continuity.
In physiological transections, the fundamental cause of irreversible damage to the
spinal cord is loss of blood supply. The blood supply of the spinal cord is tenuous,
especially in the thoracic region. Injury to the anterior spinal artery is the most common
cause of spinal cord ischemia. Damage to the microcirculation, especially that of the
central gray matter, is associated with compression-type injuries and edema formation.
Closed trauma tends to cause vascular injuries. Axial loads are associated with
displacement of bone elements or herniated disc material, with resultant compression
injury. High-velocity missile wounds in the paravertebral area, even in the absence of
direct contact, can cause neurological injury. The missile need not pass directly through
neural tissue to induce injury. The pathological events which lead to injury at some
distance from the actual projectile track are tissue contusion and/or hemorrhage produced
by either radial stretching of the tissue around the missiles path during formation of the
temporary cavity or fragmentation of the projectile and bone resulting in multiple
secondary missiles. The destructive nature of high-velocity missiles explains the futility
of decompressive laminectomy in the management of these wounds.
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Operational Medicine 2001
Health Care in Military Settings
Bureau of Medicine and Surgery
Department of the Navy
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Washington, D.C
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Operational Medicine
Health Care in Military Settings
CAPT Michael John Hughey, MC, USNR
NAVMED P-5139
January 1, 2001 |
United States Special Operations Command
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MacDill AFB, Florida
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