Spinal Damage

Injuries to the back account for less than 10% of skiing injuries, but damage to the spine can potentially be extremely serious. Speed is the main factor in spinal injuries on the ski slopes. The faster you go, the more traumatic force is subjected to your spine if you have an accident. Generally spinal injuries are more common amongst male skiers.

The Spinal Cord Explained

The spine comprises 24 vertebrae: 7 cervical (neck), 12 thoracic (chest) and 5 lumbar (lower back). There are ligaments and muscles attached to each vertebra, which facilitate movement in the back and protect the bones from damage. There is also cartilage between each vertebra, which acts as a shock absorber for the spine. The spine stretches from the base of the skull to the coccyx and supports the weight of the head and trunk.

What Causes a Spinal Cord Injury?

Most back injuries result from crashing into other skiers or chairlift accidents. There are two main ways the spine can get injured:

1. Flexion/hyper-extension: if a sudden impact forces the neck forwards and backwards very sharply, too much strain is put on the front and/or back of the vertebrae, causing damage (like a whiplash injury).
2. Compression: if direct compression forces the spine downwards, the bones are pushed on top of each other.

Very serious spinal injuries can result in paralysis. Even if the casualty still has full movement and feeling in their limbs, it is better to be on the safe side after a nasty collision and assume there may be some spinal damage. Extra care should be taken especially if the casualty is unconscious and/or has:

• fallen more than 10 feet
• extensive injuries above the collarbone
• multiple injuries
• suffered a high impact collision

Spinal Injury Symptoms

If the casualty displays any of the following symptoms, a spinal injury is likely:

• loss of function in limbs
• pain anywhere in the back from the neck to the bottom
• loss of feeling anywhere in the body

If the casualty is unconscious and their heart rate and blood pressure has dropped significantly, they may be suffering from spinal shock. This can result from trauma to the spine, preventing the nervous system from transmitting signals and it could last for several weeks, depending on the severity of the injury.

Prevention

The best ways to prevent spinal injury is to take lessons before your skiing holiday and keep your speed down when you are on the slopes. Novice skiers are 10 times more likely to sustain an injury than experienced skiers and skiing too fast, especially if you are not skilled enough to cope with the speed, is the major risk factor in spinal injuries. Wearing a helmet is also very important and will help to protect you, but they are less effective when skiers have an accident at a high velocity because the trauma from the impact is carried up the spine.

Treatment

Immediately after injury

How a spinal injury is dealt with in the immediate aftermath and the first 8 hours after sustaining the injury is crucial. The casualty's airway, breathing and circulation (ABC) should be checked. Extra care should be taken to keep the back as still as possible, unless it is too dangerous to leave the casualty in that position and not moving them may result in further injury. The casualty should be fitted with a rigid cervical collar and placed on a spinal board or stretcher before being taken to hospital. Steroids may be injected into the back to reduce spinal swelling and X rays will be taken to assess the damage.

Surgery

Surgery may be performed 8 hours after the injury has occurred. Surgeons will use spinal instrumentation (rods, bars, wires and screws) in conjunction with fusion techniques (bone grafts) to stabilize and support the spine, correct misalignments and repair damage.

In some cases it may be decided that the bones should heal naturally without surgical intervention. If this is the case, the casualty will be put in traction and will have to remain immobilised in bed for about 2 months.