CERVICAL SPINE INJURY DURING AUTO COLLISION

The first two articles in this series were about head trauma and in particular concussions. Any car accident has the potential to cause physical damage to your body. Understanding the most common injuries and why they occur can provide you with information that will help you understand what treatment you will need. While the advent off airbags and protective changes in construction of automobiles have helped to prevent many more severe injuries but indirectly force is transferred to the major.....

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CEREBAL CONCUSSION FROM AUTO COLLISION

Over 1.5 million people suffer for a traumatic brain injury due to a motor vehicle collision each year. These injuries are not only from direct trauma, such as your head sticking to steering wheel, head rest, or window. They can also occur from sudden flexion/extension of one’s neck or a sudden twisting motion.

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CONCUSSION - SYMPTOMS AND TREATMENT

Cerebral concussion has become a topic of increased importance, especially with contact sports. Concussion can occur as a result of a blow to the head. It can also occur with a sever jolting of the head, where the brain “bounces around” inside the bony confines of the skull. Concussion is classified as brain dysfunction due to a closed head injury. In severe cases the brain can be irreparably damaged. However, in most cases, after a sports or automobile injury, the brain is only temporarily damaged.


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CERVICAL SPINE INJURY DURING AUTO COLLISION

The first two articles in this series were about head trauma and in particular concussions. Any car accident has the potential to cause physical damage to your body. Understanding the most common injuries and why they occur can provide you with information that will help you understand what treatment you will need. While the advent off airbags and protective changes in construction of automobiles have helped to prevent many more severe injuries but indirectly force is transferred to the major movable object which is us. The extent off injuries is determined by the speed, direction of impact and our body position at the time of accident. In particular these deacceleration injuries cause torque to our bodies and in particular to our spine. In this article, we will discuss the mechanism of injury to our neck occurring when we are reared. Though the same mechanism can be applied when hit from other directions and effect the rest of our musculature including our mid and lower back.


The cervical spine has two main functions. It is the main I-beam and structural support to keep the head upright and centered on your body. It allows the head to swivel, bend forward and backward, and bend side to side. The second function of the bony spine is to be the bony protective conduit for the spinal cord to exit the brain and enter the more protective thoracic area.

Most motor vehicle collisions with seat-belt restrained passengers avoid direct impact of the head against the steering wheel or windshield. Instead, the major injury concern is the neck region, including the cervical spine and the surrounding muscular and ligamentous supports. Normally these surrounding soft tissue structures are designed to move the neck and head as well as protected the neck and head from rapid acceleration and deceleration injuries. They try and dissipate the rapid forces that occur when your automobile is abruptly stopped from a forty mile-per-hour pace to a dead stop in less than a second. Without the slowing-down of these forces by a movable spine, all automobile collisions would result in catastrophic events.


Normal, non-injurious forces to the spine allow the body to initiate muscle contraction at a rate that will slowly decrease the rate at which the head and neck are forced forward or backward during an automobile collision. At the extremes of motion, the fibrous ligaments that connect each spinal vertebra to the adjacent vertebrae act as check reins and do not allow any more motion to occur.


When the acceleration and deceleration forces are beyond what the body can

adjust for or when the body is unprepared for the rapid forces to the spine, the spinal safeguards that normally protect the cervical spine are exceeded. This frequently occurs when a driver is not expecting a collision to occur.


During a rear-end automobile collision, your body goes through extremely rapid and intense acceleration and deceleration. At each phase, there is a different force acting on the body that contributes to the overall injury. This sudden and forceful movement can cause substantial damage to the vertebrae, nerves, discs, muscles, and ligaments of your neck and spine.


During the first phase, your car begins to be pushed out from under you, causing your mid-back to be flattened against the back of your seat.  This results in an upward force in your cervical spine, compressing your discs and joints.  As your seat back begins to accelerate your torso forward, your head moves backward, creating a shearing force in your neck.  If your head restraint is properly adjusted, the distance your head travels backward is limited.  However, most of the damage to the spine will occur before your head reaches your head restraint.


During phase two, your torso has reached peak acceleration – 1.5 to 2 times that of your vehicle itself  – but your head has not yet begun to accelerate forward and continues to move rearward.  An abnormal S-curve develops in your cervical spine as your seat back recoils forward, much like a springboard, adding to the forward acceleration of the torso. Unfortunately, this seat back recoiling forward occurs while your head is still moving backward, resulting in a shearing force in the neck that is one of the more damaging aspects of a cervical injury.  Many of the nerve, disc, ligament and muscle injuries occur during this phase.


During the third phase your head and neck are at their peak forward acceleration. At the same time, your car is slowing down from applying the brake or from confronting another vehicle or immovable abject. As you move forward in your seat, any slack in your seat belt and shoulder harness is taken up. Your torso is stopped by your seat belt and shoulder restraint and your head is free to move forward unimpeded. This results in a violent forward-bending motion of your neck, straining the muscles and ligaments and tearing fibers in the spinal discs. Your spinal cord and nerve roots get stretched and irritated, and your brain can strike the inside of your skull causing a mild to moderate brain injury (concussion).


Most motor vehicle related cervical injuries are muscular and ligamentous. These injuries cause symptoms, including neck pain and stiffness, headache, upper back pain, shoulder pain, and inability to engage in normal home and work activity. Many of these symptoms do not occur immediately at the time of the collision but rather become increasingly symptomatic over a few hours to a few days.


After proper examination to rule out more serious causes of pain, a course of management directed at alleviation of the symptoms is warranted. Treatment decreases the overall length of time that symptoms last. Treatment also decreases the severity of the symptoms, therefore allowing a more normal lifestyle during the healing process.


Every accident victim should be treated as an individual and not be compared to a group with similar injuries. Each  individual  has a different pain threshold and a different expectation as to what is needed to function in their daily environment. A course of treatment should be tailored specifically for everyone.

HOWARD D. MARKOWITZ, MD


more articles by HOWARD D.MARKOWITZ