Back Trauma - Causes, Symptoms, Diagnosis, and Treatment

Introduction

The region between the neck and the pelvic area is the back region. It comprises the vertebral column (spinal cord), intervertebral disks, joints, and two compartments of muscles, namely, the intrinsic and extrinsic muscles, nerves, and blood vessels. The main functions of the back include; the protection of the spinal cord, maintaining a proper posture, coordination of limb movements, assisting respiration, and supporting the body weight. The bones and muscles help coordinate the head position with the body movements preventing extreme flexion and extension.

What Is Back Trauma?

An injury affecting any area of the back region, including bones, muscles, nerves, or blood vessels, may be termed back trauma. Injuries to the lower back region are commonly seen, causing severe pain and discomfort and limiting movements. It can happen suddenly (acute) or slowly over time (chronic). It may be due to fractures, wear, and tear, developmental disorders, or direct injuries to the backbones and muscles.

What Are the Types of Back Trauma?

Different types of back trauma include:

• Back Pain: Pain in the back region due to injuries, exerting excessive force on the back muscles such as lifting heavy objects, occupational reasons like sitting or standing for long periods, sudden twisting or turning movements, or due to age-related diseases. It may be a dull and achy pain or a sharp and stabbing pain, depending on the cause.

• Back Sprain and Strain: A tear in the ligament or stretching of a muscle, leading to inflammation and spasm. It usually causes severe pain and restricts movement. The spasm of the muscles results in the immobilization of the muscles, preventing further damage to the ligaments and joints.

• Herniated Disks: Bulging or inflammation, or rupturing of the intervertebral disks (cushion-like material in between the vertebrae) causes irritation to the nerves. It leads to severe pain, which radiates to other parts of the body, like the neck, legs, and feet.

• Fracture of Vertebrae: Direct injuries to the back, such as vehicle accidents or a blow to the back, may lead to fractures. It may be a simple compression fracture wherein there may be a break only in the bone or a complex or a burst fracture wherein the bones get displaced along with the injury to the soft tissues. Fractures lead to severe pain and swelling and also limit movement.

• Spondylolisthesis: A spinal disorder where the vertebra slips out of its position onto the bone below it, leading to severe pain, muscle stiffness, and nerve crowding resulting in numbness. It may occur due to developmental deformities, sports injuries, trauma, or abnormal wear and tear of the cartilage or bones.

• Cervical radiculopathy: Damage to the cervical nerves or nerve roots due to a ruptured disk or degeneration of the bones, which applies pressure on the nerve roots. It leads to pain, weakness, or loss of sensation in the neck, arms, and shoulders.

What Are the Causes of Back Trauma?

Causes of back trauma include:

• Sports injuries that occur during football, weight lifting, athletics, gymnastics, etc.

• Physical workouts at the gym or during physical exercises at home.

• Vehicle accidents may cause significant trauma to the back.

• Sudden movement or a fall while working at home or in the garden, lifting heavy objects.

• A blow or a knock, gunshot wounds on the back due to violence.

• Muscle strain due to overuse or repetitive movements like twisting, turning, rotating, etc.

What Are the Signs and Symptoms of Back Trauma?

Some of the signs and symptoms include:

• Pain and tenderness increase during coughing, sneezing or laughing.

• Pain that may radiate to one or both legs.

• A pop was heard at the time of injury.

• Weakness or paralysis, or deformity in any area of the body.

• Fever, muscle spasms, or cramps.

• Swelling and bruises are present.

• Difficulty in breathing.

• Difficulty in urination and passing stools.

• Numbness or pricking sensation in arms, legs, hands, and feet.

• Stiffness of muscles, difficulty in walking, bending or standing straight.

What Are the Risk Factors That May Lead To Back Trauma?

• Developmental disorders include scoliosis (side curvature of the spine), lordosis (inward curvature of the spine), and spina bifida (spinal column not developed properly).

• Age-related diseases like osteoarthritis (inflammation of joints due to wear and tear of cartilage), osteoporosis (low bone density), disk degeneration (wear and tear of the intervertebral disk), and spondylosis (degeneration of the spine). Other conditions include kidney stones, tumors, fibromyalgia (severe muscle pain and tenderness), etc.

• Occupation-related back injuries due to lifting heavy weights or industrial hazards.

• Excessive body weight, inactive, or a desk job.

• Improper posture, sitting or driving for long hours without proper back support.

• Smoking can cause reduced blood supply and oxygen to the intervertebral disks, leading to the degeneration of disks.

• Psychological disorders like depression, stress, anxiety, etc., may increase back pain.

What Are the Complications of Back Trauma?

Some of the complications due to back trauma include:

• Injury to the spinal cord may cause loss of bowel and bladder control, resulting in urinary tract infections, kidney stones, or bladder stones.

• Loss of sensation may also lead to pressure sores and inflammation.

• Circulatory disturbances may occur due to spinal cord injuries resulting in the swelling of the extremities and an increased risk of developing blood clots.

• Difficulty in breathing and risk of infections like pneumonia or other lung diseases.

• Muscle flaccidity (lack of muscle tone) or muscle atrophy (wasting of muscles) may lead to obesity and cardiovascular diseases.

How Is Back Trauma Diagnosed?

A complete history is taken, followed by a physical examination. Mild muscle sprains and strains are diagnosed based on the history, symptoms, and physical examination. Severe fractures of the spinal cord require emergency treatment. After a thorough physical examination, the neurological status and anal muscle tone of the patient are assessed. Loss of bowel and bladder control may indicate a severe spinal nerve injury. A radiological examination is necessary in case of injuries, fractures, herniation of disks, or loss of function. It includes:

• X-rays are recommended to determine the fracture location, type, and extent and rule out any developmental abnormalities.

• Computed tomography (CT Scan) is preferred in some cases to confirm the diagnosis as it provides a high-resolution and clear image as compared to X- rays.

• Magnetic resonance imaging (MRI) is considered the gold standard for diagnosing back injuries, herniated disks, and neurological diseases, as it helps detect soft tissue involvement.

How Is Back Trauma Managed?

Back trauma can be managed by conservative and surgical methods, depending on the cause and severity of the injury or the condition. Conservative management is carried out in cases of mild sprain, inflammation, and muscle spasms. It includes:

• In mild to moderate pain cases, medications like nonsteroidal anti-inflammatory drugs such as Ibuprofen, Ketoprofen, Naproxen, Acetaminophen, etc., and steroidal injections are administered in cases of severe pain and spondylolisthesis and cervical radiculopathy.

• Cold or heat therapy may reduce pain, swelling, and muscle spasms.

• Physical activities may be reduced, and bed rest is advised for a few days.

• Yoga and physical exercises under proper guidance may be advised to prevent muscle atrophy.

Surgical management is required in severe fractures and herniated disks and is proven effective compared to non-surgical procedures. It includes:

• Vertebroplasty and Kyphoplasty: Vertebroplasty is a procedure during which a fine needle is inserted into the vertebral body, and a glue-like bone cement is injected into the space, which hardens and strengthens to provide relief from pain. During kyphoplasty, before injecting the cement, a special balloon-like material is inserted, which is inflated, to restore the height and reduce the spinal deformity.

• Discectomy: It is performed in cases of severe degeneration of the disks, wherein the degenerated disc is removed and replaced with an artificial disc.

• Spinal Nerve Stimulation: In cases of injury to the spinal nerves, it is stimulated by using low-voltage electric impulses from an implanted device connected by a wire along the length of the spinal cord. These impulses are mainly designed to block the pain impulses sent to the brain.

• Decompressive Laminectomy: This procedure is performed in cases of severe pain despite conservative therapy. It involves widening the spinal canal to provide more space for the nerves, spinal fusion is performed, or an implant device stabilizes the spinal cord, permitting normal movement.

• Fracture of the Vertebrae: The management of vertebral fractures depends on the fracture pattern, nerve involvement, and associated injuries. Stable fractures are treated by bracing for around six to 12 weeks, and unstable fractures with nerve involvement, severe forward bending, and loss of vertebral height require surgical management. Laminectomy is performed, and the fracture is stabilized using metal rods and screws.

How Can Back Trauma Be Prevented?

• Back injuries due to accidents may be prevented by driving safely and slowly and following instructions like wearing seatbelts, speed limits, etc.

• Maintaining a proper posture with back support while sitting for long periods.

• Installation of grab bars and non-slip mats, especially for elderly individuals and children.

• Using safety gear and all precautionary measures during sports and practice sessions, and spotters in case of gymnastics.

• Maintaining body weight by following a healthy diet and regular exercise.

• Avoid smoking as it causes the reduced blood supply to tissues and organs.

• Treatment of conditions like osteoporosis and osteoarthritis to prevent fractures.

Conclusion

Trauma to the back region may occur due to direct injuries, fractures, muscle sprains, degeneration of the intervertebral disks, or developmental disorders. It is associated with severe pain, inflammation, loss of function, and numbness. It needs to be managed appropriately to avoid further complications. Certain precautionary measures can be taken to avoid back trauma. It can be successfully treated by conservative and surgical management depending on the type and severity of the trauma.