The neck and back are home to the spinal column, also known as the vertebral column, which is comprised of the spine and the spinal cord. Vertebrae run from the base of the skull down to the sacrum. These vertebrae surround and protect nerves that send signals through both arms and legs, and to your brain. Damage to these areas can be life-altering and result in side effects such as loss of sensation, numbness, tingling, and pain, and in extreme cases, paralysis or death. Symptoms vary depending on which regions of the spine are damaged.
Skeletal Spinal Anatomy
The cervical spine is the area supporting the neck and brain. It is made up of seven vertebrae, referred to as C1 through C7. The bones get larger as they go down the spine. The top of the cervical region controls most of the rotation of the neck whereas the lower vertebrae allow us to move our necks forward to our chests and backward, known as flexion and extension.
Healthy bones in this area of the spine naturally curve inward toward the front of the body to assist in movement, and in support of the head and neck. Doctors often refer to the natural curvature of the spine as lordosis. Similar lordosis is also seen in the lumbar spine. Post-accident x-rays often show a loss of this naturally occurring curvature of the spine. It may be indirect evidence of damage to the spine caused by muscle spasm in the area surrounding the spine due to trauma.
Damage to this area can result in symptoms as mild as a stiff neck or as serious as quadriplegia (paralysis and loss of sensation in the arms and legs). Commonly, people with damage to their cervical spine experience pain, and tingling and numbness in their neck and upper back which can flow all the way through their arms and fingers and down to their toes. Some have trouble extending their fingers, wrists or elbows. The cervical spine protects the most vital nerves in the spinal cord, including those controlling not only movement but breathing.
The thoracic spine is directly below the cervical spine and above the lumbar spine. It consists of 12 vertebrae (T1 through T12) which help with lifting and stability. Damage to this region is rare, but when it occurs, it commonly presents as upper back pain and stiffness.
The ribcage provides support for the thoracic spine and limits motion in this region. The relative immobility serves a vital role, protecting the heart and lungs from damage. Because the ribcage connects to the spine in the thoracic region, many people who suffer from thoracic disc herniations after an accident also suffer from broken or bruised ribs and resulting chest pain.
The lumbar spine, aptly named after the lion for its strength, sits below the thoracic spine and consists of five vertebrae. This region alone supports the weight of the entire torso. It begins about five inches below the shoulder blades and curves inward toward the front of the body, keeping us stable and giving us flexibility. Similar to the cervical spine, a loss of this lordosis (naturally occurring curvature of the spine) may be a result of trauma-related damage to the spine caused by muscle spasm in the area.
The lumbar spine is the area of the spine most prone to injury because it performs the brunt of the work day in and day out. While it is regularly seen in lifting injuries at work, it is also one of the most common injuries to the spine in a vehicle crash. Injury to the L5-S1 area can result in sciatic pain when the damaged vertebrae put pressure on or compress the nerve.
Lower back pain may be an indicator of disc herniation or compression, but it is not the only possibility. Injuries to larger muscles such as the trapezius or "traps" (extending from the neck and shoulders through the mid back) and latissimus dorsi or "lats" (in the mid back) can result in the lumbar region carrying the weight those muscles usually help to support. Generally, muscle strains usually heal on their own within a few weeks. Damage to the spine itself is more troublesome and should always be evaluated by a medical professional.
The sacral region of the spine is a triangular shaped bone situated at the bottom of the spine, between the two sides of the pelvis. The sacrum connects the spine to the lower half of the body. Initially made up of five vertebrae, these vertebrae fuse as we age and become one solid bone around age thirty. The first sacral vertebra meets the last lumbar vertebra at the lumbosacral joint (L5-S1) to allow for rotation of the body while walking, running, sitting, etc. Damage to the sacroiliac joint and the surrounding vertebrae can lead not only to debilitating pain, but also to difficulties walking, bending or swiveling in a chair.
The tailbone, or coccyx, lies at the bottom most point of the sacrum. Persistent pain in this region is referred to as coccydynia. It generally worsens with sitting, transitioning from sitting to standing, or any activity that puts pressure on the bottom of the spine. Coccyx pain affects more women than men, perhaps because it is prone to injury during childbirth or because women have a wider and shorter sacrum than men, putting more pressure on the coccyx. Men, however, are not immune from the injury.
Any trauma to the area, such as from a car accident or a serious slip and fall, can lead to severe tailbone pain. In rare cases, surgery may be performed to remove the coccyx entirely, but most people who suffer from tailbone pain find non-surgical and rehabilitative therapy to be effective treatment.
Spinal Cord and Nerves
The spinal cord does not run along the entire spine. It begins at the base of the brain and ends above the lumbar region. This is why damage to the upper back, but very rarely the lower back, may result in spinal cord damage and paralysis. As the spinal cord reaches the lumbar region, the nerve roots branch out and form the cauda equina.
Nerves are messengers which convey sensations throughout the body. Damage to nerves can cause disruption of the messages resulting in pain, numbness, increased sensitivity or complete lack of sensation as well as limited or complete loss of muscle function controlled by the nerve.
The cauda equina, or horse’s tail, is a group of nerve roots that branch out from the spinal cord just above the lumbar region of the spine. These nerves reach out to the bladder, colon and pelvic organs, and extend all the way down the back of each leg as sciatic nerves. Pressure and swelling of these nerves can be caused by narrowing of the spinal canal or compression of nerves within the lumbar spine. This rare condition, referred to as Cauda Equina Syndrome, if not treated promptly can result in incontinence, lower back pain and loss of feeling or changes in sensations in the legs and feet, including numbness, tingling and pain. Surgery to release the pressure in the nerves may be required.
The sciatic nerve is the largest nerve in the human body. It runs from the right and left sides of the lower lumbar spine all the way through the back of both legs to the feet. Pain felt anywhere along the sciatic nerve is referred to as sciatica. It is commonly caused by damage or irritation of the nerve root near L5 and S1. Pressure to the nerve root can send signals of pain down the entire sciatic nerve, but it usually only affects one side of the body. These signals can also result in loss of function of certain parts of the feet and legs. Some people even experience drop foot (weakening of the muscles that permit flexing the foot, causing the front of the foot to drag while walking) or constant burning or shooting pains through the buttocks and back of the legs.