Spinal trauma
Vertebral fractures & spinal cord injuries — Emergency management
What is spinal trauma?
Spinal trauma refers to any injury to the vertebral column resulting from an impact: road traffic accident, fall from height, sporting accident or diving injury. The severity ranges enormously, from a simple muscular bruise with no lasting consequence to an unstable fracture with spinal cord compression.
The cervical region is the most vulnerable, due to its mobility and exposed position: one third of all spinal injuries involve the neck. It is also at this level that neurological consequences can be most severe, since the cervical spinal cord controls all four limbs.
Types of injuries
Spinal injuries are classified according to the structures involved and the stability of the spinal column:
• Vertebral fracture: compression (wedge), burst or fracture-dislocation depending on the mechanism of trauma
• Dislocation: displacement of one vertebra relative to another, with ligament damage — an often unstable injury
• Traumatic disc herniation: the impact can cause sudden disc rupture with acute nerve compression
• Spinal cord injury: the most feared complication — compression, contusion or severance of the spinal cord, potentially leading to paralysis
Symptoms & Clinical signs
The clinical picture depends on the severity of the trauma and the degree of neurological involvement:
• Spinal pain: intense and immediate pain at the point of impact, worsened by the slightest movement
• Muscle guarding: a protective reflex — the body "locks" the muscles around the injured area
• Neurological signs: tingling, numbness, weakness or paralysis of the limbs — their presence demands immediate immobilisation and urgent investigation
• Spinal shock: sudden loss of all motor and sensory function below the injury — the initial phase of a severe cord injury
• Sphincter dysfunction: loss of bladder or bowel control — a sign of severity and an absolute emergency
Diagnosis
The diagnostic work-up follows a rigorous protocol, often carried out as an emergency:
• Whole-body CT scan: performed urgently, it maps all bony injuries with great precision
• Spinal MRI: essential if neurological signs are present — shows the condition of the cord, any haematomas and traumatic disc herniations
• Dynamic X-rays: performed later, under controlled conditions, to assess spinal stability
• Classification: fractures are graded according to their stability (AO/Magerl system) to guide treatment decisions
Treatment
Treatment depends on the stability of the fracture and the neurological status:
Conservative treatment
• Brace or cervical collar: for stable fractures without neurological involvement — immobilisation for 6 to 12 weeks
• Painkillers and initial rest
• Progressive rehabilitation after bony healing (approximately 90 days)
Surgical treatment (often performed as an emergency)
• Decompression: freeing the spinal cord and nerves if bone fragments are compressing them
• Instrumented fixation: stabilising the spine with metal screws and rods to allow healing in the correct alignment
• Reduction: correcting displacement (dislocation) and restoring spinal alignment
• Urgency: in cases of cord compression, every hour counts — early decompression significantly improves the neurological outcome
Key figures
One third
Of spinal injuries involve the cervical region, the most vulnerable area
45%
Of spinal injuries are caused by road traffic accidents
90 days
Average time for bony healing of a vertebral fracture
Recovery and rehabilitation
Recovery after spinal trauma depends primarily on the severity of the initial injury and whether there is neurological involvement. For stable fractures without neurological damage, wearing a brace for 6 to 12 weeks allows bone healing. Rehabilitation then begins gradually, with a return to normal activities between 3 and 6 months.
After instrumented fixation surgery, patients are encouraged to mobilise within the first few postoperative days. The hospital stay averages 7 to 14 days depending on the complexity of the procedure. Rehabilitation is supervised by a multidisciplinary team: physiotherapist, occupational therapist and rehabilitation physician. In cases of spinal cord injury, care is provided in a specialised rehabilitation centre for several months. The most significant improvements occur within the first 6 to 12 months, but further progress remains possible beyond this period thanks to neuronal plasticity.
Consultation with Dr Dimitriu
Dr Christian Dimitriu, a neurosurgeon specialising in spine surgery, is involved in the management of spinal trauma, whether as an emergency for unstable fractures or cord compression, or in planned consultations for follow-up and treatment decisions. He practises in facilities equipped with a full technical platform (CT scanner, MRI, 24-hour operating theatre).
During the consultation, Dr Dimitriu reviews all imaging (CT scan, MRI, dynamic X-rays), assesses the patient's neurological status and determines the optimal treatment strategy. He places great importance on informing the patient and their family, clearly explaining the diagnosis, treatment options, expected outcomes and the rehabilitation pathway. Follow-up is personalised, with regular consultations and radiographic checks to verify bone healing and spinal alignment.
Prevention
Preventing spinal injuries relies above all on road safety (seatbelts, correctly adjusted headrests, speed limit compliance), which remains the primary protective factor. In sport, following the rules, appropriate warm-up and wearing protective equipment (helmets for cycling, skiing, horse riding) significantly reduce the risk.
Fall prevention in older adults is also essential: home modifications, maintaining physical activity to preserve balance and muscle strength, vision correction, and reviewing medications that increase fall risk. In the workplace, adherence to safety regulations for working at height and handling heavy loads helps prevent spinal injuries.
Consultations in Île-de-France
Dr Dimitriu practises at 4 facilities in the Paris region (Île-de-France), easily accessible from central Paris: Clinique de l'Yvette (Longjumeau), Hôpital Privé d'Antony, Clinique du Mont-Louis (Les Lilas) and Hôpital Privé de l'Ouest Parisien (Saint-Cloud). See addresses and book an appointment.
Frequently asked questions
Do not move the victim unless there is an immediate life-threatening danger (fire, drowning). Keep the head and neck aligned with the body — do not turn or bend them. Call emergency services immediately. Cover the victim to prevent hypothermia and reassure them while waiting for help. Early immobilisation is essential to protect the spinal cord.
The prognosis depends on whether the injury is complete or incomplete. In incomplete injuries (where some function is preserved), significant recovery is possible, especially if surgical decompression is performed promptly. Complete injuries have a more guarded prognosis, but intensive rehabilitation can always optimise remaining function and independence.
For a stable vertebral fracture without neurological damage, rehabilitation lasts 2 to 4 months after bone healing. In cases of spinal cord injury, rehabilitation is much longer — several months to a year in a specialised centre — and continues on an outpatient basis. The most significant improvements occur in the first 6 to 12 months.
Yes, in most cases, after the fracture has fully healed (approximately 3 to 6 months) and with appropriate rehabilitation. The return is gradual and medically supervised. Low-impact sports are resumed first. Returning to contact or high-risk sports requires medical clearance and well-strengthened spinal musculature.
Sources: SOFCOT · The Lancet Neurology · WHO (World report on injury prevention).