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

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