IV. Spinal Cord Lesions
A. General comments.
The spinal levels most commonly involved with injury are the lower cervical spine (C4, C5, C6, C7, T1) and the thoracolumbar juncture (T12, L1, L2), the areas of greater mobility.
B. Pathophysiology - Mechanisms of injury
a. Direct injury results from force applied directly to the back of the neck or trunk and may cause fractures of spinous processes of laminal arches, concussion of the spinal cord, or direct compression of neural tissue by depressed bone fragments. Lacerations can result from knife or bullet wounds.
b. Indirect injury is a more common mechanism resulting from forces applied to the head and trunk or from movements that exceed the normal range, e.g. when the head is suddenly accelerated or decelerated in relation to the trunk.