How does a spinal cord injury happen?

A spinal cord injury is ‘damage to the spinal cord that results in a loss of function such as mobility or feeling.’ This type of injury is most often caused by a traumatic blow to the spinal cord such as during a car accident, severe fall, or an act of violence. There must be ‘a sudden, traumatic blow to your spine that fractures, dislocates, crushes, or compresses one or more of your vertebrae,’ or when a gun shot or knife penetrates your spinal cord. After a spinal cord injury, bleeding, inflammation, swelling occurs and fluid builds up in and around the spinal cord. Without immediate treatment, this can lead to permanent paralysis or death. 

The higher in the back or neck the spinal cord injury occurs, the more dysfunction a person will have as a result. So with a spinal cord injury that occurs from a blow to the neck, a person usually loses function in the arms and legs. The ability to control your limbs after a spinal cord injury depends on where along the spinal cord the injury took place, and how severe the injury is. 

When someone injures their spinal cord, there are a number of signs and symptoms that can occur very shortly after it happens. This includes ‘extreme back pain, pressure in your neck, head or back, weakness, incoordination or paralysis in any part of the body, difficulty with balance and walking, impaired breathing after injury, and oddly positioned or twisted neck or back.’

Now let’s talk about the crushed larynx. A crushed larynx, also known as a laryngotracheal injury, is pretty rare in adults, except when there is blunt force trauma to the front of the neck, such as strangulation, or blows to the trachea from fists or feet. This is usually caused by a car accident when the passenger does not have a seatbelt on, in the front seat, or driving, and there are no protective air bags. In this case, the person in the front seat or driver is thrown forward and the front of the neck either hits the dashboard or steering wheel. The direct blow to the front of the neck crushes the larynx against the spine of the neck. This type of injury can also occur during sports, fights, falling forward onto a blunt object such as the handle bars of a bicycle, or during strangulation. Depending on the severity of the impact, the larynx and trachea can compress against the spine.

This can cause a spinal cord injury. In order for this to happen, there would have to have been a direct blow to the front of his neck, which is unlikely to have been a self-imposed injury in the back of the van. If the blow to the front of the neck is severe and/or low, the larynx and trachea can become completely separated, causing airway obstruction and difficulty breathing. With this type of injury, the neck must be immediately ‘stabilized to prevent worsening of unrecognized cervical spine injuries.’ 

It is unclear whether which injury happened first, if one caused the other, or how it happened. There are many possibilities. The fact is that from a medical standpoint, it is unlikely that Freddie Gray injured himself in the back of that van. The severity of his injuries seem too severe for him to have done that himself just by thrashing around or banging his head on something. It is more likely that there was some type of direct blow to either the front or back of his neck, or somewhere along the spinal cord on his back.