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Chapter 2 presents information on spinal cord injury, the physical impairments that result, and secondary conditions.

INTRODUCTION

Every year an estimated 17,810 peoplea in the United States sustain spinal cord injuries (SCIs). Today, there are approximately 294,000 people with spinal cord injuries alive in this country.1

In the United States, motor vehicle accidents are the most common cause (38.6%) of spinal cord injury, followed by falls (32.2%), acts of violence (14.0%), sports injuries (7.8%), and medical or surgical causes (4.2%). The remaining 3.2% of spinal cord injuries result from other causes.1 The incidence of the different causes of cord injury changes over time and varies with gender, race, age, employment status, and marital status, being influenced by the activities and hazards prevalent in each population.2-5 A large majority of spinal cord injuries (approximately 80%) are sustained by males. The average age at the time of injury is 43 years.1

aThis number does not include people who die at the scene of the accident.

ANATOMY REVIEW

Clinicians working with patients who have spinal cord injuries should have basic knowledge of the anatomy of the vertebral column, spinal cord, vascular supply, and spinal nerves. This knowledge will enable them to understand the clinical manifestations of spinal cord injuries.

Vertebral Column

Most spinal cord injuries are the result of trauma to the vertebral column, which contains 7 cervical, 12 thoracic, 5 lumbar, 5 sacral, and 4 coccygeal vertebrae. The cervical, thoracic, and lumbar vertebrae are separated by intervertebral disks. The sacral and coccygeal vertebrae are fused.

A typical vertebra consists of a body, located anteriorly, and an arch. The spinal cord is encased within the vertebral foramen, which is formed by the vertebral bodies and arches. Figure 2-1 illustrates the components of a vertebra.

Figure 2-1.

Components of a vertebra. (A) Superior view. (B) Lateral view.

The vertebral column is stabilized by ligaments (Fig. 2-2). The anterior longitudinal ligament is attached to the anterior aspect of the vertebral bodies and intervertebral disks; it limits extension. The posterior longitudinal ligament is attached to the posterior aspect of the vertebral bodies and intervertebral disks; it limits flexion.4,5 The ligamenta flava, supraspinous ligament (C7 and below), ligamentum nuchae (cervical region), interspinous ligaments, and articular capsules stabilize the posterior arch.5-7

Figure 2-2.

Ligaments stabilizing the spinal column.

Spinal Cord

The spinal cord extends from the medulla oblongata just above the foramen magnum to the level of the L1 or L2 vertebra.8 Its tapered caudal end is ...

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