How the body recovers after a spinal cord injury. Spinal cord injury: treatment and rehabilitation. Decompression for spinal cord compression

One of the most severe pathologies of the back is a rupture of the spinal cord. It can lead to loss of sensation in the limbs and even death of the patient. The prognosis for future life for a victim of a back injury depends on the degree of damage to the nerve fibers and the effectiveness of the selected treatment.

Spinal cord rupture is a severe injury to nerve fibers, in which there is a violation of their integrity and subsequent tissue necrosis.

Occurs under high compression loads, penetrating wounds, and increased mechanical loads on the spine. The degree of damage to the spinal cord can vary. More often, partial ruptures are observed, in which a complete recovery of the patient is possible. Complete ruptures are less common. Patients are often interested in whether it is possible to restore the functions of internal organs and limbs below the level of nerve fiber rupture. Unfortunately, the current level of development of medicine does not make it possible to do this.

The consequences of spinal cord injury are unpredictable. Partial or complete paralysis, disturbances in the functioning of certain organs, and curvature of the back may occur. In this case, the patient can maintain clarity of consciousness all the time.

Causes

• Injuries sustained in road accidents. They are more often observed in pedestrians or motorcyclists, since their back is not protected by a hard seat back.
• Injuries caused by a person falling from a height, including falls from bridges or other structures, or jumping into water.
• Domestic injuries. These include falls from stairs, knife wounds, and gunshot wounds. In older people, brain ruptures can occur even as a result of falling from their own height.

Also, serious back injuries can be sustained by a child during natural childbirth or during a caesarean section.

Symptoms

The main manifestation of severe back injury is spinal shock. When a person’s brain is disconnected from his organs, numbness sets in. During this period, any movement of the patient can lead to deterioration of the condition and death.

In severe cases, respiratory or cardiac arrest may occur.

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Diagnostics

Myelography is also used to determine the degree of compression of nerve fibers. Additional studies are prescribed to the patient depending on the presence of concomitant injuries to the body, acute and chronic diseases.

First aid

1. Place the victim on a hard, flat surface. During the cold season, it is recommended to cover the patient with a blanket.
2. Turn the victim's head to the side. This is necessary so that the patient does not choke on vomit.
3. Call emergency assistance. Notify your doctor about back injuries.
4. If possible, a cotton-gauze collar should be placed around the patient's neck for additional support of the spine.

In case of back injuries, it is strictly forbidden to lift the person’s body, pull him by the arms or legs, adjust the vertebrae on his own, or lay the victim on a soft surface. All this can aggravate a person’s condition.

Treatment

Upon admission to the hospital, the patient is given high doses of potent medications that can support the vital activity of damaged nerve fibers. After this, the patient is prescribed surgical treatment. It involves the removal of spinal fragments that injure the spinal cord, as well as restoration of blood supply to damaged tissues. Next, the patient is prescribed drug therapy aimed at maintaining the body and rapid tissue regeneration.

After completing the main course of treatment, the person undergoes repeated diagnostics, including MRI, X-rays, general examinations, and liquorodynamic tests. Based on the results of this study, the patient is prescribed rehabilitation therapy. It may involve the use of drug therapy, physical therapy. procedures, manual therapy aimed directly at restoring the back muscles. If a person shows positive dynamics, he will be prescribed physical therapy, swimming and sanatorium treatment.

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Full recovery after nerve fiber rupture takes a year and a half or more.

Forecast

In case of severe back injuries, the prognosis for the patient directly depends on the severity of the brain damage, the speed of providing assistance to the patient and the effectiveness of the chosen treatment methods. If the fiber rupture is incomplete and the patient was given first aid correctly, complete recovery of the body is possible.

Do you walk with a ruptured spinal cord? If a person had minor damage to nerve fibers, he underwent full treatment and further rehabilitation, then complete restoration of the musculoskeletal system is possible. In such cases, the victim will be able to walk in the future.

If the patient has a complete rupture of the spinal cord, the consequences of the injury can be extremely severe. In some cases, victims experience complete paralysis. Death in patients with back injuries occurs due to respiratory arrest or heart failure.

Spinal cord injury is a dangerous pathological condition for humans in which the integrity of the spinal canal is partially or completely disrupted. Symptoms of the disorder can be different; it directly depends on the type of injury. Patients with injuries are hospitalized urgently.

When the spinal canal is damaged, a person experiences neurological disorders, localized mainly to the bottom of the affected area of ​​the spinal column.

Statistics say that most injuries occur due to:

• Road accidents (almost half of the cases);
• Falls (the elderly especially often injure the spine);
• Gunshot and knife wounds;
• Participation in some sports (motorsports, diving, etc.).

In more than half of clinical cases, injuries to back structures are diagnosed in young and middle-aged men.

Damage can be localized in different parts of the spine, but most often the thoracic or lumbar regions are affected.

All damage is divided into two categories. The injury may be:

1. Closed—the skin over the injury is intact;
2. Open - the soft tissues above the site of injury to the spinal column are injured.

With open injuries, the risk of infection of the spinal membranes and the canal itself increases. Open injuries, in turn, are divided into non-penetrating and penetrating (the inner wall of the spinal canal or the hard spinal membrane is damaged).

Injuries to the spinal column may damage the ligamentous apparatus (rupture or tear of the ligament), vertebral bodies (various types of fractures, cracks, separation of endplates, dislocation, fracture dislocation), spinous and transverse arches/articular vertebral processes.

Fractures of different parts of the vertebra with single or multiple displacements can also occur.

According to their mechanism, injuries to the nervous and bone structures of the spine are divided into:

• Flexion. A sharp bend causes a rupture of the posterior ligamentous apparatus and dislocation occurs in the area of ​​the 5-7 cervical vertebrae;
• Hyperextension. It is characterized by rough extension, accompanied by rupture of the anterior group of ligaments. With such an injury, compression of all structures of the column occurs, as a result of which the vertebra pops out and a protrusion is formed;
• Vertical compression fracture. Due to movements along the vertical axis, the vertebrae are subject to dislocation or fracture;
• Fracture due to lateral flexion.

Injuries of a stable and unstable nature are distinguished separately. Fractures of the explosive type, rotation, dislocations and fractures of various degrees are considered unstable. All these injuries are necessarily accompanied by rupture of ligaments, due to which the structures of the spinal column are displaced and the spinal roots or the canal itself are injured.

Stable fractures include fractures of the vertebral processes and wedge-shaped/compression fractures of their bodies.

Clinical forms of SM injuries

The severity of spinal cord injury and its course in early or late stages largely depend on the intensity of spinal shock. This is the name of a pathological condition in which motor, reflex and sensory sensitivity is impaired in the area located below the injury.

Injuries cause loss of motor function, decreased muscle tone, dysfunction of the subphrenic organs and structures located in the pelvis.

Spinal shock can be maintained by bone fragments, foreign particles, and subcutaneous hemorrhages. They are also capable of stimulating disruption of hemo- and liquor dynamics. Clusters of nerve cells located next to the traumatic focus are in a severely inhibited state.

The clinical picture of the injury depends on the type of spinal cord injury. Each injury differs in its characteristics; their symptoms are largely similar to each other.

When a concussion occurs, an irreversible process occurs in which the function of the spinal cord is disrupted. Characteristic symptoms of injury:

1. Violation of reflex reactions in the tendons;
2. Pain spreading down the back;
3. Loss of muscle tone;
4. Generalized or partial loss of sensitivity at the point of injury;

There are usually no motor disturbances, but there may be a feeling of tingling and numbness in the legs. With a spinal cord concussion, symptoms last a maximum of a week, after which they regress.

Injury

This is a more complex and dangerous injury; the prognosis in this case is not so favorable. The injury may be:

• Lungs - bone and muscle structures are not damaged;
• Medium - a hematoma is formed and nerve structures are damaged. There is also a risk of injury to spinal tissue and infection through cracks, which can cause sepsis;
• Severe - nerve conduction is disrupted, causing the medulla oblongata to swell and thromboembolism and thrombosis to develop.

With a spinal cord injury, patients experience complete or partial paralysis of the legs/arms (depending on the location of the injury), impaired muscle tone, dysfunction of the pelvic organs, hyposensitivity and the absence of some reflexes, which occurs due to rupture of the reflex arc.

Most often, compression occurs due to swelling, hemorrhages, damage to the ligamentous apparatus and intervertebral discs, fragments of parts of the vertebrae or foreign bodies. Spinal cord compression can be:

1. Dorsal;
2. Ventral;
3. Internal.

There are cases when compression is both dorsal and ventral. This usually happens with complex injuries. Compression of the spinal canal and roots is manifested by complete or partial loss of motor function in the arms and legs.

When crushed, a partial rupture of the spinal canal occurs. For several months in a row, the patient may continue to experience symptoms of spinal shock, which manifests itself as follows:

• Disappearance of somatic and autonomic reflexes;
• Paralysis of legs/arms;
• Decreased muscle tone in the limbs.

With a complete anatomical rupture of the spinal canal, patients lack all skin and tendon reflex reactions, parts of the body below the point of injury are not active, there is uncontrolled urination and defecation, thermoregulation and the process of sweating are disrupted.

Such an injury can be characterized as a single or multiple avulsion of the roots, their compression or bruise with subsequent hemorrhage. The clinical picture depends in part on which nerve roots are damaged.

Common symptomatic manifestations of the lesion include:

1. Point pain;
2. Rein sign (bilateral roller-shaped muscle spasm on the sides of the spinous process of the corresponding vertebra);
3. Swelling over the affected root;
4. Impaired sensory perception (if the roots of the cervical spine are affected, the arms and legs are affected, the thoracic or lumbar spine - only the legs;
5. Dysfunction of the pelvic organs;
6. Vegetative-trophic disorders.

If the roots in the cervical spine (level 1-5 vertebrae) are damaged, the patient experiences pain in the back of the head and neck, and tetraparesis. Respiratory processes, swallowing and local circulation may also be impaired. In addition, patients with cervical root injuries experience stiffness in neck movements.

If the roots at the level of 5-8 cervical vertebrae are damaged, various forms of paralysis of the arms and legs occur. When the thoracic roots are partially affected, Bernard-Horner syndrome is observed.

If the thoracic roots are damaged, abdominal reflexes disappear, the activity of the cardiovascular system and sensitivity are disrupted, and paralysis occurs. By the zone of hyposensitivity, you can determine at what level the roots are affected.

Damage to the nerve roots at the level of the lumbar spine and cauda equina is manifested by a violation of the innervation of the pelvic organs and lower extremities, and the presence of burning pain in the injured area.

With hematomyelia, blood flows into the spinal cavity and a hematoma appears. Most often this occurs when vessels located near the central spinal canal or posterior horns in the lumbar or cervical enlargement rupture.

The symptoms of hematomyelia are caused by compression of the gray matter and segments of the spine by blood fluid.

A characteristic symptom of such an injury is inhibition of sensitivity to pain and temperature, multiple bruises on the back.

Symptomatic manifestations of hematomyelia last about 10 days and then begin to subside. In the event of such an injury, there is a chance of full recovery, but dysfunction may occasionally return during life.

In many clinical cases, injury to the spinal cord and spine entails many complications. The most global of them is disability and being confined to a wheelchair. Unfortunately, some patients are completely deprived of motor function and doctors cannot help in this situation.

In addition, they develop other background pathologies:

• Sexual impotence;
• Muscle spasticity;
• Bedsores;
• Shoulder tendinitis (this occurs due to constant manual operation of a manual wheelchair);
• Dysreflexia of the autonomic nervous system;
• Problems with the respiratory system;
• Disturbances in the urinary tract and intestines (especially uncontrolled urination and defecation, impaired intestinal motility);
• Formation of blood clots in deep veins;
• Embolism of arteries in the lungs;
• Uncontrolled weight gain.

If motor function is still preserved, patients have to actively restore it and literally learn to walk again. However, spinal cord injuries almost never go away without leaving a trace.

Due to impaired conduction of nerve impulses and lack of muscle tone, patients may experience rare disorders of various organ systems.

Patients who have previously suffered injuries to the spinal column and spinal cord become more susceptible to various other injuries. Against the background of injuries, patients experience impaired sensitivity and can injure themselves without even noticing it.

These patients should always exercise extreme caution when performing potentially hazardous work and check themselves for injury upon completion.

A patient who has suffered a spinal cord injury is always referred to a neurosurgeon for examination. He assesses the severity of the injury and assigns it a certain category:

1. A-category - paralysis of the body below the point of injury;
2. B-category - the body below the point of injury is sensitive, but the patient cannot move;
3. C-category - sensitivity is present and the patient can move, but cannot walk;
4. D-category - sensitivity is present and the patient can move and walk, but only with the help of another person or a supporting device;
5. E-category - sensitivity and motor function below the point of injury are preserved.

For in-depth diagnosis, doctors use instrumental studies. Patients may be prescribed:

Treatment tactics

Patients with spinal cord and spinal injuries should be hospitalized immediately. Treatment of injuries is usually multi-stage. This may include:

• Surgical intervention. Used in different periods of trauma treatment. After the operation, the patient undergoes a long rehabilitation period. In some clinical cases, one patient may undergo several multi-purpose operations;
• Drug therapy. Used mainly to combat neurological disorders, restore metabolism, increase reactivity, stimulate conductivity and enhance capillary blood flow;
• Physiotherapeutic techniques. They are used to accelerate regenerative and reparative processes, restore the activity of the musculoskeletal system and pelvic organs, increase the compensatory capabilities of the body, prevent contractures and bedsores. For this purpose, sessions of UHF, magnetic therapy, ultraviolet radiation, thermal procedures, electrophoresis and others are carried out;
• Exercise therapy. It is carried out for the same purpose as physiotherapy. In some clinical cases, physical therapy is prohibited, so only a doctor should prescribe it and select a set of exercises;
• Treatment in a sanatorium-resort institution. In them, patients with spinal cord injuries will be able to receive proper care and provide all the conditions for recovery. In addition, in such institutions there are almost always doctors present who can be consulted.

Conclusion

Injury to the spinal cord and spinal column is a serious injury that, in the worst case, can result in disability. Depending on the severity of the injury and its location, the patient will experience a certain clinical picture.

Diagnosis of injuries consists of several instrumental procedures. Treatment is mainly surgical in combination with supportive therapy.

Spinal cord injury is damage due to injury or disease to any part of the spinal cord or nerves of the spinal canal. These injuries often cause impairment or loss of motor or sensory function.

Many scientists do not give up the idea that spinal cord damage will one day be completely reversible. Therefore, research in this area is being conducted all over the world. At the same time, treatment and rehabilitation programs that exist today allow many patients to once again become active members of society.

The ability to control the limbs of the body after a spinal cord injury depends on two factors: the location of the injury (part of the spinal cord) and the severity of the injury. If the spinal cord is seriously damaged, the pathways that connect several parts of the spinal cord together are destroyed, then the consequences of a spinal injury are catastrophic.

The severity of injury is divided into:

Complete damage

Such an injury leads to loss of sensitivity and motor functions of all organs and parts of the body located below the level of injury.

Incomplete damage

With an incomplete spinal cord injury, the organs and limbs located below the injury site retain partial motor activity.

Also, spinal cord injuries can lead to tetraplegia (aka quadriplegia) - impairment or loss of the functions of the arms, torso, legs and functions of the pelvic organs.

Paraplegia is complete paralysis or paralysis affecting part of the torso, legs and pelvis.

• Your doctor will perform a series of tests to determine the neurological level of damage and the severity of the injury.
• Signs and symptoms of spinal cord injury (may manifest as several or one of the following):
• loss of motor functions,
• loss of sensation, including the ability to sense heat, cold, or touch.
• loss of bowel and bladder control
• increased muscle tone or uncontrollable spasms
• sexual dysfunction and infertility
• pain or tingling caused by damage to the nerve fibers of the spinal cord
• difficulty breathing, cough.

The first signs of a spinal cord injury:

• Severe back pain or pressure in the neck and head
• Weakness, incoordination, or paralysis in any part of the body
• Numbness, tingling, or loss of sensation in the hands, fingers, feet, or toes
• Loss of bowel or bladder control
• Difficulty walking and maintaining balance
• Respiratory problems

When to see a doctor

Anyone who suffers a serious head or neck injury should seek immediate medical attention. Doctors will also evaluate possible spinal cord damage. Whenever a spinal cord injury is suspected, doctors must perform all appropriate medical procedures until proven otherwise, this is important because:

• A serious spinal injury is not always immediately obvious. If it is not recognized in time, it can lead to more serious consequences.
• Numbness or paralysis may also not appear immediately, and without prompt diagnosis, the situation can be worsened by prolonged internal bleeding and swelling in or around the spinal cord.
• The time elapsed after the injury and medical care directly affects possible complications and subsequent rehabilitation of the patient.

How to behave with a person who has just been injured:

1. Call 1719 or the nearest hospital ambulance service.
2. Place towels on both sides of your head and neck to keep them stationary and wait for emergency help.
3. Provide first aid to the victim: take measures to stop the bleeding and provide comfort to the victim as much as possible, but without moving the neck or head.

Spinal cord injury may result from damage to the vertebrae, ligaments, or discs of the spine. Traumatic spinal cord injury may involve a sudden blow to the spine that fractures, dislocates, or compresses the vertebrae. Spinal cord injury can also be caused by a gunshot or knife wound. Complications usually occur within days or weeks after the injury due to bleeding, swelling, inflammation, and fluid accumulation in and around the spinal cord.

Non-traumatic spinal cord injury is also possible due to a number of diseases: arthritis, cancer, inflammation, infection or spinal disc degeneration.

Your Brain and Central Nervous System

The central nervous system consists of the brain and spinal cord. The spinal cord, made up of soft tissue surrounded by bones (vertebrae), runs down from the base of the brain, made up of nerve cells and their processes, and ends slightly above the waist. Below this area there is a bundle of nerve endings called the cauda equina.

The nerve branches of the spinal cord are responsible for communication between the brain and the body. Motor neurons transmit signals from the brain to control muscle movement. Sensory areas carry signals from body parts to the brain to convey information about heat, cold, pressure, pain, and limb position.

Damage to nerve fibers

Regardless of the cause of spinal cord injury, the nerve fibers passing through the injured area may also be affected. This leads to deterioration in the functioning of the muscles and nerves located below the site of injury. Damage to the thoracic or lumbar region can affect the functioning of the muscles of the trunk, legs and internal organs (bladder and bowel control, sexual function). And neck injuries can affect arm movement and even the ability to breathe.

Common Causes of Spinal Cord Injury

The most common causes of spinal cord injury in the United States are:

Road traffic accidents. Automobile and motorcycle accidents are the leading cause of spinal cord injury, accounting for more than 40% annually.

Falls. Spinal cord injuries in older adults (over 65 years of age) are usually associated with falls. In general, statistics assign ¼ of all cases to this reason.

Acts of violence. 15% of spinal cord injuries are caused by violence (including gunshots and knife wounds). Data from the National Institute of Neurological Disorders and Stroke.

Sports injuries. Professional sports carry many dangers, as do active recreation, for example, shallow water diving. 8% of back injuries fall under this heading.

Alcohol. Every fourth injury is, in one way or another, related to alcohol use.

Diseases. Cancer, arthritis, osteoporosis and inflammation of the spinal cord can also cause damage to this organ.

Despite the fact that such injuries usually occur as a result of an accident, a number of factors have been identified that predispose to risk, such as:

Gender. Statistically, there are many times more men affected. In the United States, there are only 20% of women with similar injuries.

Age. As a rule, injuries occur at the most active age - from 16 to 30 years. The main cause of injury at this age remains road accidents.

Love of risk and extreme sports. Which is logical, but the main thing is that athletes and amateurs are the first to get injured when safety precautions are violated.

Diseases of bones and joints. In the case of chronic arthritis or osteoporosis, even a minor injury to the back can be fatal for the patient.

After spinal cord injuries, patients face a large number of unpleasant consequences that can radically change their lives. When such a serious injury occurs, a team of specialists comes to the patient’s aid, including neurosurgeons, neurologists and doctors from a rehabilitation center.

Specialists of the Rehabilitation Center will offer a number of methods for monitoring vital processes (bladder and intestinal function). A special diet will be developed to improve organ function, which will help avoid future formation of kidney stones, urinary tract and kidney infections, obesity, diabetes, etc. Under the supervision of experienced physiotherapists, an exercise program will be developed to improve the patient's muscle tone. You will receive detailed recommendations on skin care to avoid bedsores and maintain the functioning of the cardiovascular and respiratory systems. Specialists in urology and infertility treatment may also be involved if necessary. Doctors will teach you how to deal with pain and depression. We are able to offer an integrated approach to completely stabilize the patient's condition.

Medical Research:

Radiography. This is where it makes sense to start the research. The images give a general picture of the situation, allow you to assess the deformation of the spine, detect fractures, dislocations of vertebral bodies and processes, and clarify the level of damage.

Computed tomography (CT). A CT scan provides more detailed information about the damaged area. During the scan, the doctor takes a series of cross-sectional images and provides a detailed examination of the walls of the spinal canal, its membranes and nerve roots.

Magnetic resonance imaging (MRI). MRI makes it possible to obtain images of the entire length of the spinal cord in different projections. And it will be very useful in identifying herniated discs, blood clots and other masses that can compress the spinal cord.

A few days after the injury, when the swelling has subsided, the doctor may perform a neurological examination to determine the severity of the injury. It includes testing muscle strength and sensory sensitivity.

Unfortunately, spinal cord damage cannot be completely cured. But ongoing research is providing doctors with more and more new tools and techniques to treat patients that can promote the regeneration of nerve cells and improve nerve function. At the same time, we should not forget about the work that is being done in the field of maintaining an active life for patients after injury, expanding opportunities and improving the quality of life of people with disabilities.

Providing emergency medical care

Providing prompt first aid is critical to minimizing the consequences after any head or neck injury. Likewise, treatment of a spinal cord injury often begins at the scene of the accident.

Upon arrival, the emergency medical team should immobilize the spine as gently and quickly as possible using a rigid cervical collar and a special stretcher to transport the victim to the hospital.

When a spinal cord injury occurs, the patient is taken to the intensive care unit. The patient may also be taken to a regional spinal cord injury center where a team of neurosurgeons, orthopedic surgeons, psychologists, nurses, therapists and social workers is always on duty.

Medicines. Methylprednisolone (Medrol) is used in cases of acute spinal cord injury. When treated with Methylprednisolone within the first eight hours after injury, there is a chance of obtaining a moderate improvement in the patient's condition. This drug reduces damage to nerve cells and relieves inflammation of tissues around the site of injury. However, it is not a cure for the spinal cord injury itself.

Immobilization. Stabilization of the injured spine during transport is extremely important. To do this, the team has special devices in its arsenal to hold the spine and neck motionless.

Surgical intervention. Often, doctors are forced to resort to surgery to remove bone fragments, foreign objects, herniated discs, or fix vertebral fractures. Surgery may also be needed to stabilize the spine to prevent pain or bone deformity in the future.

Hospitalization period

Once the patient has been stabilized and initial treatment has been provided, staff begin working to prevent complications and related problems. This may include deterioration in the patient's physical condition, muscle contracture, bedsores, bowel and bladder dysfunction, respiratory infections and blood clots.

The length of hospital stay depends on the severity of the injury and the pace of recovery. After discharge, the patient is sent to the rehabilitation department.

Rehabilitation. Work with the patient can begin in the early stages of recovery. The team may include physiotherapists, occupational therapists, specially trained nurses, a psychologist, a social worker, a dietician and a supervising physician.

In the initial stages of rehabilitation, therapists typically work to preserve and strengthen muscle function by using fine motor skills and teaching adaptive behaviors in everyday activities. Patients receive advice on the consequences of injuries and the prevention of complications. You will be given recommendations on how you can improve your quality of life under current conditions. Patients are taught new skills, including the use of special equipment and technologies, which make it possible not to depend on outside help. Having mastered them, you can find a new hobby, participate in social and sporting events, return to school or the workplace.

Drug treatment. The patient may be prescribed medications to control the effects of a spinal cord injury. These include medications to control pain and muscle spasms, as well as medications to improve bladder control, bowel control, and sexual function.

New technologies. Today, modern means of transportation have been invented for people with disabilities, providing complete mobility for patients. For example, modern lightweight electric wheelchairs. Some of the latest models allow the patient to independently climb the stairs and lift the seated person to any required height.

Forecasts and recovery

Your doctor will not be able to predict the recovery of just an admitted patient. In case of recovery, if it can be achieved, it will take from 1 week to six months after the injury. For another group of patients, small improvements will come after a year of working on oneself or more time.

In the event of paralysis and subsequent disability, you need to find the strength to accept the situation and start a different life, adaptation to which will be difficult and frightening. A spinal cord injury will affect every aspect of life, whether it be daily activities, work or relationships.

Recovery from such an event takes time, but it is up to you to choose whether you will be happy in the current situation, and not the injury. Many people have gone through this and were able to find the strength to start a new full life. One of the main components of success is quality medical care and support from loved ones.

Thank you

The site provides reference information for informational purposes only. Diagnosis and treatment of diseases must be carried out under the supervision of a specialist. All drugs have contraindications. Consultation with a specialist is required!

Spinal injuries: prevalence, causes and consequences

Prevalence of spinal injuries

The prognosis for spinal injuries combined with spinal cord damage is always very serious. Disability in such cases is 80-95% (according to various sources). A third of patients with spinal cord injuries die.

Damage to the spinal cord is especially dangerous due to injuries to the cervical spine. Often such victims die at the scene from respiratory and circulatory arrest. The death of patients in a more distant period after injury is caused by hypostatic pneumonia due to impaired ventilation, urological problems and bedsores with transition to a septic state (blood poisoning).

Injuries to the spinal column and spinal cord in children, including birth trauma to the spine, are more amenable to treatment and rehabilitation due to the greater adaptive capabilities of the child’s body.

It should be noted that the consequences of spinal injuries are largely determined by the period of time from injury to the start of complex treatment. In addition, very often ineptly provided first aid significantly aggravates the victim’s condition.

Treatment of spinal injuries is complex and lengthy, often requiring the participation of several specialists (traumatologist, neurosurgeon, rehabilitation specialist). Therefore, in many countries, patients with serious injuries to the spinal column are concentrated in specialized centers.

Anatomical structure of the spine and spinal cord

Anatomy of the spinal column

Each vertebra consists of a body located anteriorly and an arch that limits the vertebral foramen posteriorly. The free vertebrae, with the exception of the first two, have seven processes: spinous, transverse (2), upper articular (2) and lower articular (2).
The articular processes of adjacent free vertebrae are connected in joints that have strong capsules, so that the spinal column is an elastic, movable joint.

The vertebral bodies are connected into a single whole by elastic fibrous discs. Each disc consists of an annulus fibrosus, within which is located the nucleus pulposus. This design:
1) ensures mobility of the spine;
2) absorbs shocks and loads;
3) stabilizes the spinal column as a whole.

The intervertebral disc is devoid of blood vessels; nutrients and oxygen are supplied by diffusion from neighboring vertebrae. Therefore, all restoration processes occur here too slowly, so that with age a degenerative disease develops - osteochondrosis.

Additionally, the vertebrae are connected by ligaments: longitudinal – anterior and posterior, interspinal or “yellow”, interspinous and supraspinous.

The first (atlas) and second (axial) cervical vertebrae are not similar to the others. They have been modified as a result of human upright walking and provide connection between the head and the spinal column.

Atlas does not have a body, but consists of a pair of massive lateral surfaces and two arches with upper and lower articular surfaces. The upper articular surfaces articulate with the condyles of the occipital bone and provide flexion and extension of the head, while the lower ones face the axial vertebra.

A transverse ligament is stretched between the lateral surfaces of the atlas, in front of which is the medulla oblongata, and behind it is a process of the axial vertebra, called the tooth. The head, together with the atlas, rotates around the tooth, and the maximum angle of rotation in any direction reaches 90 degrees.

Anatomy of the spinal cord

Normally, between the spinal canal and its contents there is a reserve space that allows you to painlessly tolerate natural movements of the spine and minor traumatic displacements of the vertebrae.

The spinal cord in the cervical and lumbosacral regions has two thickenings, which are caused by the accumulation of nerve cells to innervate the upper and lower extremities.

The spinal cord is supplied with blood by its own arteries (one anterior and two posterior spinal arteries), which send small branches deep into the brain substance. It has been established that some areas are supplied from several branches at once, while others have only one supply branch. This network is fed by the radicular arteries, which are variable and absent in some segments; at the same time, sometimes one radicular artery supplies several segments at once.

With a deforming injury, the blood vessels are bent, compressed, overstretched, their internal lining is often damaged, resulting in the formation of thrombosis, which leads to secondary circulatory disorders.

It has been clinically proven that spinal cord lesions are often associated not with a direct traumatic factor (mechanical trauma, compression by vertebral fragments, etc.), but with blood supply disorders. Moreover, in some cases, due to the peculiarities of blood circulation, secondary lesions can cover quite large areas beyond the influence of the traumatic factor.

Therefore, in the treatment of spinal injuries complicated by damage to the spinal cord, prompt elimination of the deformity and restoration of normal blood supply are indicated.

Classification of spinal injuries

Based on the nature of the damage, the following are distinguished:

• bruises;
• distortions (tears or ruptures of ligaments and bursae of vertebral joints without displacement);
• fractures of the spinous processes;
• transverse process fractures;
• vertebral arch fractures;
• vertebral body fractures;
• subluxations and dislocations of the vertebrae;
• fracture-dislocations of the vertebrae;
• traumatic spondylolisthesis (gradual anterior displacement of the vertebra due to destruction of the ligamentous apparatus).

Unstable injuries occur with combined damage to the posterior and anterior parts of the spine, which often occurs with a flexion-rotation mechanism of injury. Unstable injuries include dislocations, subluxations, fracture-dislocations, spondylolisthesis, and shear and sprain injuries.

Clinically important is the division of all spinal injuries into uncomplicated (without damage to the spinal cord) and complicated.

There is the following classification of spinal cord injuries:
1. Reversible functional impairment (concussion).
2. Irreversible damage (bruise or contusion).
3. Spinal cord compression syndrome (can be caused by splinters and fragments of parts of the vertebrae, fragments of ligaments, nucleus pulposus, hematoma, edema and swelling of tissue, as well as several of these factors).

Symptoms of spinal injuries

Symptoms of Stable Spinal Injuries

When a spinal bruise occurs, victims complain of diffuse pain at the site of injury. During the examination, swelling and hemorrhage are detected, movements are slightly limited.
Distortions usually occur during sudden lifting of heavy objects. They are characterized by acute pain, severe limitation of movements, pain when pressing on the spinous and transverse processes. Sometimes the phenomena of radiculitis are added.

Fractures of the spinous processes are not often diagnosed. They arise both as a result of the direct application of force and as a result of strong muscle contraction. The main signs of spinous process fractures are: sharp pain on palpation; sometimes you can feel the mobility of the damaged process.

Fractures of the transverse processes are caused by the same reasons, but are more common.
They are characterized by the following symptoms:
Payra's symptom: localized pain in the paravertebral region, increasing when turning in the opposite direction.

Symptom of a stuck heel: when lying on the back, the patient cannot lift the straightened leg from the bed on the affected side.

In addition, diffuse pain is observed at the site of injury, sometimes accompanied by radiculitis symptoms.

Whiplash injuries, which are common in intravehicular accidents, are usually classified as stable spinal injuries. However, quite often they have severe neurological symptoms. Spinal cord lesions are caused by both direct contusion during injury and circulatory disorders.

The extent of damage depends on age. In older people, due to age-related changes in the spinal canal (osteophytes, osteochondrosis), the spinal cord is more severely injured.

Signs of mid- and lower-cervical spine injuries

Injuries to the middle and lower cervical vertebrae occur in car accidents (60%), diving (12%) and falls from a height (28%). Currently, injuries to these departments account for up to 30% of all spinal injuries, a third of them occur with lesions of the spinal cord.

Dislocations, subluxations and fracture-dislocations occur quite often due to the special mobility of the lower cervical spine, and are classified into tipping and sliding. The former are characterized by pronounced kyphosis (convexity posteriorly) and widening of the interspinous space due to rupture of the supraspinous, interspinous, interspinal and posterior longitudinal ligaments. With sliding injuries, a bayonet-shaped deformity of the spine and fractures of the articular processes are observed. The victims are bothered by severe pain and a forced position of the neck (the patient supports his head with his hands). Spinal cord injuries are common, the severity of which largely determines the prognosis.

Isolated fractures of the third to seventh cervical vertebrae are diagnosed quite rarely. A characteristic symptom: pain in the damaged vertebra with dynamic load on the patient’s head (pressure on the top of the head).

Symptoms of thoracic and lumbar spine injuries

There are many classifications of injuries to the thoracic and lumbar spine, but they are all complex and cumbersome. The simplest is clinical.

According to the degree of damage, which depends on the magnitude of the applied force directed at an angle to the axis of the spine, the following are distinguished:

• wedge-shaped fractures (the shell of the vertebral body and part of the substance are damaged, so that the vertebra takes a wedge-shaped shape; such fractures are mostly stable and subject to conservative treatment);
• wedge-comminuted (the entire thickness of the vertebral body and the upper closure is damaged, so that the process affects the intervertebral disc; the injury is unstable, and in some cases requires surgical intervention; may be complicated by damage to the spinal cord);
• fracture-dislocations (destruction of the vertebral body, multiple damage to the ligamentous apparatus, destruction of the fibrous ring of the intervertebral disc; the injury is unstable and requires immediate surgical intervention; as a rule, such lesions are complicated by damage to the spinal cord).

Fractures and fracture-dislocations of the thoracic and lumbar regions have the following symptoms: increased pain in the fracture zone with dynamic load along the axis, as well as when tapping on the spinous processes. The protective tension of the rectus dorsi muscles (muscle ridges located on the sides of the spine) and abdomen is expressed. The latter circumstance requires differential diagnosis with damage to internal organs.

Signs of spinal cord damage

Movement disorders

Severe lesions of the spinal cord lead to a lack of movement in the limbs immediately after the injury. The first signs of restoration of active movements in such cases can be detected no earlier than a month later.

Motor disorders depend on the level of damage. The critical level is the fourth cervical vertebra. Paralysis of the diaphragm, which develops with lesions of the upper and middle cervical areas of the spinal cord, leads to respiratory arrest and death of the patient. Damage to the spinal cord in the lower cervical and thoracic segments leads to paralysis of the intercostal muscles and breathing problems.

Sensory disorders

The degree of severity, nature and topography of sensory impairment is of important diagnostic importance, since it indicates the location and severity of spinal cord injury.

It is necessary to pay attention to the dynamics of violations. A gradual increase in signs of sensory impairment and motor disorders is characteristic of compression of the spinal cord by bone fragments, fragments of ligaments, hematoma, a shifting vertebra, as well as circulatory disorders due to compression of blood vessels. Such conditions are an indication for surgical intervention.

Visceral-vegetative disorders

The speed of blood flow in tissues is sharply reduced, especially in areas with reduced sensitivity, microlymph drainage is impaired, and the phagocytic ability of blood neutrophils is reduced. All this contributes to the rapid formation of bedsores that are difficult to treat.

Complete rupture of the spinal cord often manifests itself in the formation of extensive bedsores, ulceration of the gastrointestinal tract with massive bleeding.

Treatment of spine and spinal cord injuries

When providing first aid, much depends on the timely diagnosis of injury. You should always remember that in the event of car accidents, falls from a height, building collapses, etc., it is necessary to take into account the possibility of damage to the spinal column.

When transporting victims with spinal injuries, all precautions must be taken so as not to worsen the damage. Such patients should not be transported in a sitting position. The victim is placed on a shield. In this case, an inflatable mattress is used to prevent bedsores. If the cervical spine is affected, the head is additionally immobilized using special devices (splints, head collar, etc.) or improvised means (sandbags).

If a soft stretcher is used to transport a patient with a spinal injury, the victim should be placed on his stomach, and a thin pillow should be placed under the chest for additional extension of the spine.

Depending on the type of spinal injury, treatment at the hospital stage can be conservative or surgical.

For relatively mild, stable spinal injuries (distortions, whiplash injuries, etc.), bed rest, massage, and thermal procedures are indicated.

In more severe cases, conservative treatment consists of closed correction of deformities (simultaneous reduction or traction) followed by immobilization (special collars and corsets).

Open surgical removal of the deformity relieves compression of the spinal cord and helps restore normal blood circulation to the affected area. Therefore, increasing symptoms of spinal cord damage, indicating its compression, are always an indication for urgent surgical intervention.

Surgical methods are also used in cases where conservative treatment is ineffective. Such operations are aimed at reconstructing damaged segments of the spine. In the postoperative period, immobilization is used, and if indicated, traction is used.

Victims with signs of spinal cord injury are hospitalized in the intensive care unit. In the future, such patients are supervised by a traumatologist, neurosurgeon and rehabilitation specialist.

Rehabilitation after spinal and spinal cord injuries

Rehabilitation for spinal cord injuries is supplemented by electrical pulse therapy and acupuncture. Drug treatment includes a number of drugs that enhance regeneration processes in nervous tissue (methyluracil), improve blood circulation (Cavinton) and intracellular metabolic processes (nootropil).

To improve metabolism and speed up recovery after injury, anabolic hormones and tissue therapy (vitreous body, etc.) are also prescribed.

Today, new neurosurgical methods (transplantation of embryonic tissues) are being developed, techniques for performing operations that reconstruct the affected segment are being improved, and clinical trials of new drugs are being conducted.

The difficulties of treatment and rehabilitation after spinal injuries are associated with the emergence of a new branch of medicine - vertebrology. The development of the region is of great social importance, since, according to statistics, spinal injuries lead to disability for the most active part of the population.

A spinal cord injury is a life-threatening condition that requires emergency medical care. This pathology is called traumatic spinal cord disease (TSCD).

The spinal cord, being part of the nervous system, acts as the main coordinator of the work of all organs and muscles. It is through it that the brain receives signals from throughout the body.

Each segment of the spinal cord is responsible for one or another organ from which it receives reflexes and transmits them. This determines the seriousness of the pathology in question. Such injuries have high mortality and disability.

The reasons why spinal pathologies occur can be divided into 3 groups. The first includes developmental defects, which can be either acquired or congenital. They are associated with a violation of the structure of this organ. The second group includes various diseases of the spinal cord that appear as a result of infection, hereditary predisposition or the occurrence of a tumor.

The third group includes various types of injuries, which can be autonomous and combined with a spinal fracture. This group of reasons includes:

• Falling from height;
• Auto accidents;
• Domestic injuries.

The clinical manifestations of the pathology are determined by the severity of the injury. Thus, complete and partial damage to the spinal cord is distinguished. With complete damage, all nerve impulses are blocked, and the victim has no opportunity to restore his motor activity and sensitivity. Partial damage implies the possibility of conducting only part of the nerve impulses, and thanks to this, some motor activity is preserved and there is a chance to restore it completely.

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Signs of spinal cord injury include:

• Impaired motor activity;
• Pain accompanied by a burning sensation;
• Loss of sensitivity to touch;
• Lack of sensation of warmth or cold;
• Difficulty breathing freely;
• Active cough without feeling of relief;
• Pain in the chest and heart;
• Spontaneous urination or defecation.

In addition, experts identify symptoms of spinal cord injury such as loss of consciousness, unnatural position of the back or neck, pain, which can be dull or sharp and can be felt throughout the spine.

Typology of injuries

Spinal cord injuries are classified according to the type and extent of damage.

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Hematomyelia

Hematomyelia - in this case, hemorrhage occurs into the cavity of the spinal cord and the formation of a hematoma. Symptoms such as loss of pain and temperature sensitivity appear, which persist for 10 days and then begin to regress. Properly organized treatment will allow you to restore lost and impaired functions. But at the same time, neurological disorders in the patient may remain.

Root damage

Damage to the roots of the spinal cord - they manifest themselves in the form of paralysis or paresis of the limbs, autonomic disorders, decreased sensitivity, and disruption of the pelvic organs. General symptoms depend on which part of the spine is affected. Thus, when the collar zone is damaged, paralysis of the upper and lower extremities occurs, difficulty breathing and loss of sensitivity.

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Crush

Crushing – this injury is characterized by a violation of the integrity of the spinal cord, it is torn. Symptoms of spinal shock may persist for some time, up to several months. Its result is paralysis of the limbs and a decrease in muscle tone, the disappearance of reflexes, both somatic and autonomic. Sensitivity is completely absent, the pelvic organs function uncontrollably (involuntary defecation and urination).

Squeezing

Compression - this type of injury most often occurs as a result of the action of vertebral fragments, articular processes, foreign bodies, intervertebral discs, ligaments and tendons that damage the spinal cord. This leads to partial or complete loss of motor activity of the limbs.

Injury

Bruise - with this type of injury, paralysis or paresis of the limbs occurs, sensitivity is lost, muscles are weakened, and the functioning of the pelvic organs is disrupted. After treatment, these manifestations are eliminated completely or partially.

Shake

A concussion is a reversible disruption of the functioning of the spinal cord, which is characterized by symptoms such as decreased muscle tone, partial or complete loss of sensation in those parts of the body corresponding to the level of damage. Such forms of manifestation last a short time, after which the functions of the spine are completely restored.

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Diagnostic methods

Spinal cord injuries can be of various types. Therefore, before starting treatment measures, it is necessary not only to establish the fact of injury, but also to determine the degree of its severity. This is the responsibility of the neurosurgeon and neurologist. Today medicine has sufficient means for a complete and reliable diagnosis of disorders that occurred in connection with spinal cord injuries:

• Computed and magnetic resonance imaging;
• Spondylography;
• Lumbar puncture;
• Contrast myelography.

Computed tomography is based on the action of X-ray radiation and makes it possible to identify gross structural changes and possible foci of hemorrhage. Magnetic resonance diagnostics can determine the formation of swelling and hematomas, as well as damage to the intervertebral discs.

With the help of spondylography, it is possible to detect such features of injury as fractures and dislocations of the vertebrae and arches, as well as the transverse spinous processes. In addition, such a diagnosis provides complete information about the condition of the intervertebral joints, whether there is a narrowing of the spinal canal, and if so, to what extent. Spondylography is performed in all cases of spinal cord injury and should be done in 2 projections.

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A lumbar puncture is performed if compression due to trauma is suspected. It consists of measuring the pressure of the cerebrospinal fluid and assessing the patency of the subarachnoid space or spinal canal. If obstruction is confirmed, myelography is performed. It is carried out by introducing a contrast agent and this is how the degree of compression is determined.

In case of spinal cord injury, the complex of diagnostic procedures includes assessment of functional and neurological disorders. Functional assessment is carried out based on the victim's ability to move and the presence of sensation in various parts of the body. Neurological impairment is assessed by muscle strength. In addition, an indicator of motor impairment is the ability to independently move the hips, knee, feet, wrist, little finger, thumb, and elbow. These muscle groups correspond to segments of the spinal cord.

Treatment and rehabilitation

A spinal cord injury requires immediate treatment, since only then is it possible to maintain the motor activity of the injured person. The long-term consequences of such an injury will depend on how quickly and efficiently qualified medical care was provided.

Treatment tactics and the nature of medical care provided will directly depend on the severity of the injury. To prevent the catastrophic consequences of a spinal cord injury for a person, therapeutic measures should be carried out in the following order:

1. Almost immediately after injury, injections are administered with drugs that will prevent necrosis of the nerve cells of the spinal cord.
2. Surgical removal of vertebral fragments that compress and rupture the spinal cord.
3. Supplying spinal cord cells with sufficient oxygen to prevent further death. This is done by restoring blood circulation.
4. Reliable fixation of the part of the spine that was injured.

Surgical treatment is most effective if it is performed in the first hours after injury. Auxiliary drug treatment is carried out when signs of spinal shock appear. In this case, use Dopamine, Atropine, and saline solutions. To improve blood circulation in the damaged part of the spinal cord, methylprednisolone is administered intravenously. It helps increase the excitability of neurons and the conduction of nerve impulses. It is necessary to take medications that eliminate the effects of brain hypoxia.

Since the spinal cord lacks the ability to regenerate, using stem cells for this purpose will speed up the patient’s recovery.

In the postoperative period, as part of drug treatment, antibacterial drugs are used to prevent bacterial infections, drugs that stimulate the functioning of blood vessels, since after surgery there is a high risk of developing thrombophlebitis. In addition, vitamins and antihistamines are used.

Injuries of this kind almost always have serious consequences for the neuromotor system. Therefore, restorative procedures such as massage, physical therapy, and muscle electrical stimulation are an integral part of the treatment.

Chiropractor, traumatologist-orthopedist, ozone therapist. Methods of influence: osteopathy, post-isometric relaxation, intra-articular injections, soft manual technique, deep tissue massage, analgesic technique, craniotherapy, acupuncture, intra-articular administration of drugs.