Spinal cord diseases names. Spinal cord diseases: types, symptoms, treatment. Diagnosis of spinal cord injuries

Most diseases spinal cord(myelopathy) significantly affect the patient’s quality of life and often lead to severe disability. Despite the diversity of spinal cord diseases, their clinical picture has much in common. Symptoms such as motor and autonomic disorders, as well as sensory and pain syndrome will be present almost always. Main types of diseases and pathologies of the spinal cord:

• Compression myelopathy.
• Non-compression myelopathy.
• Vascular diseases.
• Inflammatory pathologies(myelitis).
• Chronic forms of myelopathies.
• Degenerative and hereditary diseases.
• Malignant and benign neoplasms.

Let's look at the most common types and forms of spinal cord diseases.

As clinical experience shows, nerve roots rarely remain unaffected by.

Compressive myelopathy

One of the most serious illnesses compression myelopathy is considered to be a disease of the central nervous system. With this pathology, damage to the spinal cord and nerve roots will be observed, leading to the appearance characteristic symptoms motor, sensory and autonomic disorders.

Causes

Taking into account how quickly compression of the spinal cord and nerve roots develops, several types of progression are distinguished pathological process, each of which has its own cause. According to clinical practice, the following variants of compression myelopathy are distinguished:

• Spicy.
• Subacute.
• Chronic.

The acute form will be characterized by severe damage to the spinal cord and its structures with a rapid increase neurological symptoms diseases. Very little time passes from the moment of action of the damaging factor until the occurrence of a full-blown clinical picture. Most often, this condition can occur as a result of injury. spinal column or hemorrhages in the spinal cord.

Highest value In the development of acute spinal compression, among all spinal injuries, it occurs, in which displacement of vertebral fragments is observed. A typical example is a “diver’s fracture.” It is observed when the head hits the bottom while jumping into the water.

Many clinicians distinguish subacute compression as separate form a disease that can develop within 2 to 14 days. The following pathological processes contribute to its appearance:

• Rupture of intervertebral hernia.
• Growth of tumors or metastases.
• (purulent cavity).

The chronic form of the disease is usually caused by various neoplasms () with slow growth and progression. With this type of compression, clinical symptoms increase gradually, which significantly complicates diagnosis.

Damage to the nerve roots of the spinal cord (radiculitis) in the vast majority of cases is associated with a spinal pathology such as osteochondrosis.

Clinical picture

It is immediately worth noting that the nature of the symptoms is influenced by the type of compression and the level of damage to the spinal cord and nerve roots. At the same time, the rate of clinical manifestations will directly depend on what kind of compression myelopathy is observed: acute, subacute or chronic.

The most severe form of compression manifests itself. Flaccid paralysis, loss of all types of sensitivity, impairment normal operation internal organs - all this develops simultaneously. This condition is called spinal shock. Over time, flaccid paralysis changes to spastic. Pathological reflexes, convulsions and joint contractures due to muscle spasms (severe limitation in mobility) are recorded. Some features of clinical symptoms in compressive myelopathy chronic form depending on the level of damage:

• Cervical region. Low-intensity and upper shoulder girdle are noted. Skin sensitivity is impaired (numbness, tingling, etc.). Then there is weakness in the arms. Muscle tone suffers and atrophy appears.
• Thoracic department. Compression at this level is quite rare. However, if it occurs, there will be a disturbance in the motor activity of the legs and a disorder of various types of sensitivity in the torso area. There is a malfunction in the functioning of internal organs.
• Lumbar region. Chronic compression leads to dull muscle pain in area lower limbs. In addition, skin sensitivity is impaired. Over time, weakness increases, tone decreases and atrophy of the leg muscles occurs. The functioning of the pelvic organs is disrupted (urinary incontinence, problems with bowel movements, etc.).

With compressive myelopathy at any level of damage (cervical, thoracic or lumbar spine), clinical symptoms are observed that indicate a disruption in the functioning of internal organs.

Diagnostics

The appearance of characteristic symptoms of motor disorders and sensory disorders allows an experienced doctor suspect that, most likely, we are talking about diseases of the spinal cord. To date, computed tomography and magnetic resonance imaging are considered the best diagnostic methods for identifying compression myelopathy. The resolution of these methods makes it possible to identify both the exact cause of compression of the spinal cord and nerve roots, and to assess their current condition.

If for some reason it is impossible to perform a tomography, then a radiographic examination. This method makes it possible to determine the cause of compression based on the condition of the spine. X-ray photographs clearly show a fracture, dislocation of the vertebrae, intervertebral hernia, signs of degenerative diseases (osteochondrosis, etc.).

If necessary, a lumbar puncture is performed to analyze the cerebrospinal fluid. Myelography can also be used - this is radiography using a contrast agent that is injected into the cavity between meninges.

Treatment

Acute and subacute forms of compression myelopathy require emergency surgical intervention. Treatment consists of eliminating the cause that led to spinal cord damage. For chronic compression, elective surgery is usually performed.

If chronic compression of the spinal cord is associated with osteochondrosis, they may recommend complex treatment, consisting of several stages. Begin with conservative therapy, which will include:

• Taking non-steroidal anti-inflammatory drugs, vitamins and other medications.
• The use of special corsets.
• Taking courses, massage and physiotherapy.

If conservative approach does not give the desired result or progression of the clinical picture of the disease is observed, surgical treatment is resorted to. The following types of surgical intervention can be used to help eliminate factors that provoke compression of the spinal cord:

• Removal intervertebral joints.
• Removal of vertebral arches.
• Replacing a damaged disk.
• Removal of hematoma, abscess, cyst, etc.

A highly qualified specialist must supervise the treatment of any spinal cord disease.

Myelitis

An inflammatory disease of the spinal cord is called myelitis. This pathology is considered quite dangerous, since patients often get various groups disability. It’s worth noting right away that myelitis is not a disease that goes away without a trace. Severe cases may even be fatal.

Causes

Risk factors for the development of myelitis are reduced immunity and severe hypothermia. The causes of the disease can be not only infectious agents. What can trigger an inflammatory process in the spinal cord:

• Infection (viruses, bacteria, etc.).
• Injury.
• Poisoning with mercury, lead, etc. (toxic myelitis).
• Reaction to the introduction of certain vaccines.
• Radiation therapy.

Clinical picture

Myelitis will be characterized by an acute or subacute course. There are general symptoms of inflammation, such as a sharp rise in temperature, a feeling of weakness, fast fatiguability, headaches, aches in muscles and joints. Neurological symptoms begin with mild pain and a feeling of numbness in the torso (back, chest) and legs. Then, over the course of several days, symptoms of motor, sensory and autonomic disorders. Features of the clinical picture, taking into account the level of damage:

• Cervical region. There is flaccid paralysis of the arms. In this case, the lower limbs are affected by spastic paralysis. Myelitis in the upper cervical segments is characterized by damage to the arms and legs according to the type spastic paralysis, there will also be disturbances in breathing and cardiac activity. All types of sensitivity are affected.
• Thoracic department. The inflammatory process at this level leads to the appearance of spastic paralysis of the lower extremities, convulsions, and pathological reflexes. The functioning of the pelvic organs (urinary, defecation) is disrupted. In addition, there is always a sensitivity disorder.
• Lumbar region. Peripheral paresis or paralysis of both lower extremities develops. Muscle strength and tone are noticeably reduced, and deep reflexes are lost. There are dysfunctions of the pelvic organs in the form of an inability to control urination and defecation (true incontinence).

As a rule, even after treatment for myelitis, paresis and paralysis of the limbs that were affected remain. Because movement disorders recover rather slowly.

Diagnostics

The characteristic clinical picture provides compelling reasons to make a preliminary diagnosis of myelitis. To confirm the conclusion, a lumbar puncture is performed, which allows for a detailed examination of the cerebrospinal fluid.

Nature of damage and assessment of healthy people nerve structures can be done using magnetic resonance imaging.

Treatment

All patients with signs of myelitis are hospitalized in the neurological department. Priority treatment measures depend on the cause that provoked the development of the inflammatory process in the spinal cord. The following may apply therapeutic methods:

• For non-infectious myelitis, glucocorticosteroids are prescribed medications(prednisolone, hydrocortisone, etc.) in loading doses. As the condition improves, the dosage of medications is gradually reduced.
• For bacterial myelitis, antibiotics are used as much as possible. permissible dosage.
• To remove increased tone muscles use Seduxen, Mellictin or.
• To prevent the development of cerebral edema, diuretics (Furosemide, Lasix) are used.
• If urinary function is impaired, bladder catheterization is performed. A special tube is inserted to facilitate urine removal.
• Be sure to lubricate the skin with medicinal ointments or other means to prevent bedsores.
• For severe, intense pain, strong analgesics (Promedol, Tramadol, Fentanyl) are used.
• B vitamins.

The rehabilitation program includes special physical exercises, massage sessions and physiotherapeutic procedures. Recovery period may take several years.

Tumors

Regardless of the origin (vertebrae, etc.), location and growth pattern, tumors always lead to compression of the spinal cord. As statistics show, primary neoplasms Quite rarely diagnosed in children and the elderly. Meningiomas and neuromas account for more than 75% of all spinal cord tumors. There are two types of tumors:

• Extramedullary (provokes compression of nerve structures from the outside).
• Intramedullary (grow from the white or gray matter of the spinal cord itself).

Clinical picture

The location of the tumor and the nature of its growth will determine the clinical picture. An extramedullary tumor is initially characterized by pain associated with damage to the nerve roots. Then there is a slow progression of signs of spinal cord compression, manifested by paresis of the upper and/or lower extremities, sensory disturbances and disruption of the pelvic organs.

Intramedullary neoplasms are characterized by the appearance of clinical symptoms depending on the level of segmental damage. For example, if the tumor process is located in thoracic region, then there is intense girdling pain in the chest area, spastic paresis of the legs, sensitivity disorder and problems with urine output. Slow progression of neurological symptoms over several months or years will be typical for this type of tumor.

The rapid development of symptoms (paresis, paralysis, loss of sensation, etc.) may be due to tumor compression of the blood vessels that supply the central nervous system.

Diagnostics

To identify the cause of spinal cord compression, standard diagnostic measures are carried out. In most cases, the following types of diagnostics are used:

• Radiography.
• Myelography ( x-ray method with the introduction of a contrast agent).
• CT scan.
• Lumbar puncture.
• Magnetic resonance imaging.

Treatment

Typically used surgery. The effectiveness of surgery depends on the type of tumor, its location and the duration of compression of the spinal cord. If there is justifiable suspicion of compression of the nerve structures, it is administered as an emergency to reduce swelling and preserve spinal cord function. loading doses glucocorticosteroids.

Clinical experience shows that with extramedullary neoplasms accompanied by total loss motor, sensory and autonomic functions, restoration of performance can be achieved in a few months if the tumor is successfully removed. At the same time, neoplasms growing from the substance of the spinal cord are usually difficult to treat surgically.

After surgery, radiation therapy is often used. Use if necessary symptomatic therapy(painkillers, muscle relaxants, sedatives, etc.).

Spinal cord diseases, at all times, have been quite common problem. Even minor areas of damage to this most important structure of the central nervous system can lead to very sad consequences.
Spinal cord

This is the main part, along with the brain, of the human central nervous system. It is an oblong cord 41-45 cm long in adults. It performs two very important functions:

1. conductive - information is transmitted in a two-way direction from the brain to the limbs, precisely along numerous tracts of the spinal cord;
2. reflex - the spinal cord coordinates the movements of the limbs.

Spinal cord diseases, or myelopathy, are a very large group of pathological changes, different in symptoms, etiology and pathogenesis. They have only one thing in common - damage to various structures of the spinal cord. On currently There is no single international classification of myelopathies. Based on etiological characteristics, spinal cord diseases are divided into:

Spine

• vascular;
• compression, including those associated with intervertebral hernias and spinal column injuries;
• degenerative;
• infectious;
• carcinomatous;
• inflammatory.

The symptoms of spinal cord diseases are very diverse, since it has a segmental structure. TO general symptoms Damage to the spinal cord may include pain in the back, aggravated by physical activity, general weakness, and dizziness. The remaining symptoms are very individual and depend on the damaged area of ​​the spinal cord.

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Symptoms of spinal cord damage at different levels

Spinal cord segments

If the I and II cervical segment of the spinal cord is damaged, it leads to the destruction of the respiratory and cardiac centers in medulla oblongata. Their destruction leads in 99% of cases to the death of the patient due to cardiac and respiratory arrest. Tetraparesis is always noted - complete shutdown of all limbs, as well as most of the internal organs.
Damage to the spinal cord level III-V cervical segments is also extremely life-threatening. Innervation of the diaphragm ceases, and is possible only due to the respiratory muscles of the intercostal muscles. If the damage does not spread over the entire cross-sectional area of ​​the segment, it may be affected separate paths, thereby causing only paraplegia - disabling the upper or lower limbs. Damage to the cervical segments of the spinal cord in most cases is caused by injuries: a blow to the head during diving, as well as during an accident.

If the V-VI cervical segments are damaged, respiratory center remains intact, weakness of the muscles of the upper shoulder girdle is noted. The lower limbs still remain without movement and sensitivity during complete defeat segments. The level of damage to the thoracic segments of the spinal cord is easy to determine. Each segment has its own dermatome. Segment T-I responsible for the innervation of the skin and muscles of the upper chest and armpit area; segment T-IV - pectoral muscles and skin in the nipple area; thoracic segments T-V to T-IX innervate the entire region chest, and from T-X to T-XII the anterior abdominal wall. Consequently, damage to any of the segments in the thoracic region will lead to loss of sensitivity and limitation of movement at the level of the lesion and below. There is weakness in the muscles of the lower extremities, absence of reflexes of the anterior abdominal wall. Severe pain is noted at the site of injury.

As for damage to the lumbar regions, this leads to loss of movement and sensitivity of the lower extremities. If the lesion is located in the upper segments of the lumbar region, paresis of the thigh muscles occurs and the knee reflex disappears. If the lower lumbar segments are affected, the muscles of the foot and lower leg suffer.

Lesions of various etiologies of the conus medullaris and cauda equina lead to dysfunction of the pelvic organs: urinary and fecal incontinence, erection problems in men, lack of sensitivity in the genital area and perineum.

Vascular diseases of the spinal cord

Spinal cord

This group of diseases includes spinal cord strokes, which can be either ischemic or hemorrhagic. Vascular diseases of the brain and spinal cord have a common etiology - atherosclerosis. The main difference between the consequences of these diseases is the violation of higher nervous activity at vascular diseases brain, loss of various types of sensitivity and muscle paresis.

Spinal cord hemorrhagic stroke, or spinal cord infarction, is more common in young people as a result of ruptured blood vessels. Predisposing factors are increased tortuosity, fragility and incompetence of blood vessels.

It most often occurs as a result of genetic diseases or disorders during embryonic development that cause abnormalities in the development of the spinal cord. Rupture of a blood vessel can occur in any part of the spinal cord, and symptoms can be given only according to the affected segment. In the future, as a result of the movement of a blood clot with cerebrospinal fluid through the subarachnoid spaces, the lesions may spread to adjacent segments.

Ischemic stroke of the spinal cord occurs in elderly people as a result of atherosclerotic changes in blood vessels. A spinal cord infarction can cause not only damage to the vessels of the spinal cord, but also to the aorta and its branches.

As in the brain, in the spinal cord, transient ischemic attacks may occur, which are accompanied by temporary symptoms in the corresponding segment.

In neurology, such transient ischemic attacks are called intermittent myelogenous claudication. Unterharnscheidt syndrome is also distinguished as a separate pathology.

MRI diagnostics of vessels of the extremities

Intermittent myelogenous claudication occurs during prolonged walking or other physical activity. Manifests itself in sudden numbness and weakness of the lower extremities. After a short rest the complaints disappear. The cause of this disease is atherosclerotic changes in blood vessels in the lower lumbar segments, resulting in ischemia of the spinal cord. The disease should be differentiated from damage to the arteries of the lower extremities, for which MRI diagnostics of the vessels of the extremities and the aorta is performed with a contrast agent.

Spinal cord diseases (myelopathy) are a large group of pathologies that differ in many ways. The spinal cord is important organ nervous system, located in the spinal canal.

Brain tissue consists of gray and white matter. Gray matter is nerve cells, white matter is their processes. The spinal cord, whose total length is about 45 cm, is a regulator of the functionality of all internal organs, which carries out its work through the transmission of nerve impulses.

Diseases of the brain and spinal cord cause disorders that are similar in their manifestations: sensory, motor and autonomic.

Signs of diseases and types

Signs of spinal cord disease are varied. Conventionally, this organ is divided into segments associated with a specific pair of spinal nerves. Each pair is responsible for a specific area of ​​the body. It is worth noting that the nerve fibers of the gray matter intersect, so pathological processes on the left are manifested by dysfunction of the right side.

Movement disorders

Restriction of movement can be complete (paralysis) or partial (paresis). These symptoms are combined with either increased or decreased muscle tone. If the pathology affects all limbs - this is tetraparesis, two upper or two lower ones - paraparesis, one - monoparesis, the left or right half of the body - hemiparesis. As a rule, motor disturbances are symmetrical, but there are exceptions if the lesion is localized or the pathology is located in the area of ​​the cauda equina (sacrum).

Damage in area 4 is very dangerous cervical vertebra. Pathology located above it causes disruption of the diaphragm, which leads to rapid death. Pathology below the vertebra leads to breathing problems, which can end tragically if help is not provided in time.

Sensory disorders

Symptoms, nature and location of disorders depend on the location of the pathology and its degree.

Sensitivity is always lost below the level of the damaged segment.

Damage to the peripheral parts of the spinal cord leads to a decrease in superficial and skin sensitivity, as well as temperature, pain and vibration. Paresthesia (tingling, numbness) is common.

Autonomic disorders

They are manifested by changes in body temperature, sweating, metabolic disorders, changes in the nature of stool, urination, defects in the functioning of the digestive system, etc.

Painful sensations

When the spinal cord is compressed, pain appears in the middle of the back; pinched cervical nerves lead to pain in the arms; Pathology of the lumbar region is reflected by pain syndrome of the lower extremities. All symptoms of spinal cord disease depend both on the affected substance (white or gray) and on the location of the damage. There are 5 segments: cervical, thoracic, lumbar, sacral and coccygeal.

Root damage

Almost all fibers of the spinal cord roots, which are responsible for motor, sensory and autonomic functions, are almost always affected. Isolated lesions are very rare. Pathology manifests itself as follows:

• pain in the innervation zone (area of ​​influence of nerve fibers);
• numbness or tingling;
• paresthesia;
• paresis in the innervation zone (sometimes manifested by the appearance of a forced position);
• changes in the tone of innervated muscles;
• muscle tremors;
• feeling of cold or heat, impaired sweating.

Damage to several roots, unfortunately, is not excluded. This is polyradiculoneuritis. The listed symptoms get worse.

When the gray matter is damaged, the functions of a certain segment are completely completed.

Pathology of the anterior horns of the gray matter is manifested by paralysis, atrophy of muscle tissue, twitching in the affected segment, pathology posterior horns- reduction of several types of sensitivity in the affected area; lateral horns - a manifestation of Horner's syndrome (it is associated with vision and eye structures), if the defect is located at the level of the 5th cervical - 1st thoracic vertebrae.

Peripheral nerve damage

Many nerves are mixed and perform all the basic functions, so their disorders affect movements, sensitivity and autonomic functions. All this is accompanied by pain, paresis or paralysis.

Thoracic defect:

• leg paralysis;
• loss of sensitivity in the area below the ribs;
• disruption of internal organs;
• if the pathology is located in the upper thoracic region - respiratory failure;
• if there is a defect in the 3-5 thoracic vertebrae, there is a disruption in the functioning of the heart.

This pathology is characterized by paralysis and complete loss of all types of sensation in the legs and perineum, radicular pain, and severe lower back pain.

Sacral lesion

This form of the disease greatly affects the quality of life. It is characterized by:

• severe pain in the legs, perineum and sacral area;
• loss of sensitivity of the above zones;
• paresis or paralysis of leg muscles;
• reduction of all reflexes in this area;
• disruption of the internal organs of the pelvis (impotence, bowel and bladder incontinence, etc.).

Damage to the coccyx is accompanied by:

• pain in this area and in lower parts belly;
• inability to sit;
• increased pain when walking.

Causes of myelopathy

There are many reasons for the development of diseases. The main ones are:

• intervertebral hernias;
• tumor processes;
• vertebral displacement;
• traumatic injuries;
• disturbance of trophism and blood circulation;
• spinal cord stroke;
• inflammatory processes;
• complication after diagnostic measures(punctures, anesthesia, etc.).

Classification

The following myelopathies are distinguished:

• compression;
• tumors;
• consequences of intervertebral hernias;
• non-compression neoplastic myelopathies;
• myelitis (inflammatory diseases);
• vascular diseases;
• chronic myelopathies;
• degenerative and hereditary diseases.

Vascular diseases of the spinal cord are caused by thrombosis, atherosclerosis, aneurysm and other vascular defects. In 12-14% they are the cause of death. Vascular malformation is the most difficult to diagnose, as it masquerades as other diseases.

A spinal cord infarction occurs when there is a circulatory disorder, which can develop in any segment of the spine. There are many reasons and it is difficult to immediately recognize them. Symptoms such as severe back pain, decreased sensitivity, bilateral paresis of the limbs, general weakness, and dizziness are typical.

Treatment

Disease therapy is complex and complex. First of all, it is aimed at the cause of the disease, then at relieving symptoms and restoring function. A big role is given to the prevention of diseases, because everyone knows that it is easier to prevent than to cure.

Upon injury and development acute process the patient needs emergency care:

• immobilization of the patient (fixation in one position);
• air supply;
• relief from objects squeezing the neck, chest, head or abdomen.

You can give a painkiller (analgin).

Drug therapy is based on the administration of the following medications:

• hormones;
• diuretics;
• neuroprotectors.

Surgical treatment is prescribed in extreme cases and with a sharp progression of processes, severe pain.

The patient needs special care: frequent change body positions, massage, anti-decubitus pads, breathing exercises, passive flexion of the limbs.

The fast pace of life makes us rush somewhere, hurry, run without looking back. But if you have an unfortunate fall, a sharp pain pierces your back. Disappointing diagnosis from the doctor’s lips interrupts the endless rush. Spinal cord injury is a scary word, but is it a death sentence?

What is a spinal cord injury?

The human spinal cord is reliably protected. It is covered by a strong bone frame of the spine, while being abundantly supplied with nutrients through the vascular network. Influenced various factors- external or internal - the activity of this stable system may be disrupted. All changes that develop after damage to the spinal substance, surrounding membranes, nerves and blood vessels are collectively known as “spinal cord injury.”

A spinal cord injury may be called spinal or, in the Latinized manner, spinal. There are also the terms “spinal cord injury” and “traumatic spinal cord disease.” If the first concept refers, first of all, to changes that arose at the time of damage, then the second describes the entire complex of developed pathologies, including secondary ones.

Such a pathology can affect any part of the spine in which it occurs. spinal canal with the spinal cord:

• cervical;
• chest;
• lumbar.

The spinal cord is at risk of injury at any point

Classification of spinal injuries

There are several principles for classifying spinal cord injuries. Depending on the nature of the damage, they are:

• closed - not affecting soft tissues located nearby;
• open:
  • without penetration into the spinal canal;
  • penetrating:
    • tangents;
    • blind;
    • end-to-end.

The factors that provoked the damage are of considerable importance in further therapy.. According to their nature and impact, the following categories of injuries are distinguished:

• isolated, caused by point mechanical influence;
• combined, accompanied by damage to other tissues of the body;
• combined, arising under the influence of toxic, thermal, wave factors.

Depending on the nature of the damage, treatment tactics are chosen

Nosological classification is based on detailed description tissues affected, types of damage and characteristic symptoms. Its system indicates the following types of damage:

• injuries to supporting and protective components:
  • spinal dislocation;
  • vertebral fracture;
  • fracture dislocation;
  • ligament rupture;
  • spinal bruise;
• injuries to nerve components:
  • spinal cord contusion;
  • shake;
  • contusion;
  • compression (squeezing);
    • acute - occurs in a short time;
    • subacute - forms over several days or weeks;
    • chronic - develops over months or years;
  • rupture (break) of the brain;
  • hemorrhage:
    • into the brain tissue (hematomyelia);
    • between shells;
  • damage large vessels(traumatic heart attack);
  • nerve root injuries:
    • pinching;
    • gap;
    • injury.

Causes and development factors

The causes of spinal cord injuries can be divided into three categories:

• traumatic - various mechanical impacts that provoke tissue destruction:
  • fractures;
  • dislocations;
  • hemorrhages;
  • bruises;
  • squeezing;
  • concussions;
• pathological - changes in tissues caused by painful conditions:
  • tumors;
  • infectious diseases;
  • circulatory disorders;
• congenital anomalies intrauterine development and hereditary pathologies.

Traumatic injuries are the most common category, occurring in 30–50 cases per 1 million inhabitants. The majority of injuries occur among able-bodied men aged 20–45 years.

Tumor changes are a common cause of pathological lesions of the spinal cord

Characteristic symptoms and signs of damage to various parts of the spinal cord

Symptoms of a spinal cord injury do not develop overnight; they change over time. Primary manifestations are associated with the destruction of a part nerve cells at the time of injury. Subsequent mass mortality can occur for a number of reasons:

• self-destruction (apoptosis) of damaged tissues;
• oxygen starvation;
• nutritional deficiencies;
• accumulation of toxic breakdown products.

Increasing changes divide the course of the disease into five periods:

1. Acute - up to 3 days after injury.
2. Early - up to 3 weeks.
3. Intermediate - up to 3 months
4. Late - several years after the injury.
5. Residual - long-term consequences.

In the initial periods, the symptoms are shifted towards neurological symptoms (paralysis, loss of sensitivity), in the last stages - towards organic changes (dystrophy, tissue necrosis). Exceptions are concussions characterized by rapid flow and sluggish ones. chronic diseases. The cause, location and severity of the injury have a direct impact on the range of likely symptoms.

Loss of sensation and motor activity directly depends on the location of the injury

Table: symptoms of spinal cord injuries

Diagnosis of spinal cord injuries

Diagnosis of spinal cord injuries begins with clarifying the circumstances of the incident. During the interview of the victim or witnesses, primary neurological symptoms are established:

• motor activity in the first minutes after injury;
• manifestations of spinal shock;
• paralysis.

After delivery to the hospital, a detailed external examination with palpation is performed. At this stage, the patient's complaints are described:

• intensity and location of pain;
• memory and perception disorders;
• change in skin sensitivity.

Palpation reveals bone displacement, tissue swelling, unnatural muscle tension, and various deformities. Neurological examination detects changes in reflexes.

For accurate diagnosis it is necessary to use instrumental techniques. These include:

• computed tomography (CT);
• magnetic resonance imaging (MRI);
• spondylography - radiographic examination bone tissue. Performed in various projections:
  • front;
  • side;
  • oblique;
  • through an open mouth;
• myelography - radiography using a contrast agent. Varieties:
  • ascending;
  • descending
  • CT myelography;
• study of somatosensory evoked potentials (SSEP) - allows you to measure the conductivity of nervous tissue;
• vertebral angiography - a technique for studying the blood vessels that supply brain tissue;
• Electroneuromyography is a method that allows you to assess the condition of muscles and nerve endings:
  • superficial;
  • needle-shaped;
• Lumbar puncture with liquorodynamic tests is a method for studying the composition of cerebrospinal fluid.

The MRI method allows you to quickly identify changes in organs and tissues

The diagnostic techniques used make it possible to differentiate different kinds spinal injuries among themselves, depending on their severity and causes. The obtained result directly affects the tactics of further therapy.

Treatment

Considering the exceptional threat of spinal cord injuries to human life, all measures to save the victim are strictly regulated. Therapeutic measures are carried out through efforts medical personnel. Persons without special education can provide only the necessary first aid and only with clear knowledge of the actions being performed.

First aid

Even with a slight suspicion of a spinal cord injury, first aid is provided as carefully as in the case of a proven fact of injury. At worst case scenario events, the greatest risk for the victim is represented by fragments of destroyed vertebrae. Shifting in motion bone fragments can irreversibly damage the spinal cord and the vessels that supply it. To prevent such an outcome, the victim’s spine must be immobilized (immobilized). All actions must be performed by a group of 3-5 people acting carefully and synchronously. The patient should be placed on the stretcher quickly but smoothly, without sudden jerks, lifting only a few centimeters above the surface.

It should be noted that the stretcher for transporting the victim is placed under him. Carrying a non-immobilized patient even short distances is strictly prohibited.

The method of immobilization depends on the point of injury. Person with injuries in the area cervical region placed on a stretcher face up, first fixing his neck with:

• circle of soft fabric or cotton wool;
• Elansky tires;
• Kendrick tires;
• Shants collar.

Injuries to the chest or lumbar regions forced to transport the victim on a shield or rigid stretcher. In this case, the body should be in a lying position on its stomach, with a thick cushion placed under the head and shoulders.

A person with a damaged spine can be transported in a lying position: on his stomach (a) and on his back (b)

If spinal shock develops, it may be necessary to normalize cardiac activity with atropine or dopamine. Severe pain syndrome requires the administration of analgesics (Ketanov, Promedol, Fentanyl). Saline solutions and their derivatives (Hemodez, Reopoliglyukin) are used for heavy bleeding. Antibiotics wide range actions (Ampicillin, Streptomycin, Ceftriaxone) are necessary to prevent infection.

If necessary, to save the life of the victim at the scene of the incident, the following may be carried out:

• cleaning oral cavity from foreign bodies;
• artificial ventilation;
• indirect cardiac massage.

After rendering emergency care the patient should be transported immediately to the nearest neurosurgical facility. It is strictly prohibited:

• transport the victim in a sitting or lying position;
• influence the site of injury in any way.

Treatment in a hospital for bruises, concussions and other types of injuries

Kit therapeutic measures depends on the nature and severity of the injury. Minor injuries - bruises and concussions - require only drug therapy. Other types of injuries are treated in combination. In some situations that threaten irreversible changes in the spinal cord tissue, emergency treatment is required. surgery- no later than 8 hours after the moment of injury. Such cases include:

• spinal canal deformity;
• spinal cord compression;
• compression of the main vessel;
• hematomyelia.

It should be taken into account that extensive internal injuries can pose a threat to the patient's life during the operation. Therefore, if the following pathologies are present, immediate surgical intervention contraindicated:

• anemia;
• internal bleeding;
• fat embolism;
• failure:
  • hepatic;
  • renal;
  • cardiovascular;
• peritonitis;
• penetrating chest trauma;
• severe skull injury;
• shock:
  • hemorrhagic;
  • traumatic.

Drug therapy

Drug treatment continues the tactics begun during the provision of first aid: the fight against pain, infections, and cardiovascular manifestations. In addition, measures are being taken to preserve the damaged brain tissue.

1. Methylprednisolone increases metabolism in nerve cells and enhances microcirculation processes.
2. Seduxen and Relanium reduce the sensitivity of affected tissues to oxygen starvation.
3. Magnesium sulfate allows you to control the balance of calcium, therefore normalizes the passage nerve impulses.
4. Vitamin E functions as an antioxidant.
5. Anticoagulants (Fraxiparin) are prescribed to prevent thrombosis, the risk of which increases with prolonged immobility of the limbs due to spinal injuries.
6. Muscle relaxants (Baclofen. Mydocalm) relieve muscle spasms.

Photo gallery of medicines

Baclofen relieves muscle spasms Vitamin E is a powerful antioxidant Methylprednisolone enhances microcirculation processes Seduxen reduces the sensitivity of affected tissues to oxygen starvation Magnesium sulfate normalizes the passage of nerve impulses Fraxiparine is prescribed for the prevention of thrombosis

Decompression for spinal cord compression

More often greatest threat For the victim, it is not direct damage to the spinal cord that is considered, but its compression by surrounding tissues. This phenomenon - compression - occurs at the time of injury, intensifying in the future due to pathological changes. Reducing pressure on the spinal cord (decompression) is the primary goal of therapy. In 80% of cases, skeletal traction is successfully used for this.

Fixation with traction reduces pressure on the spine

Surgical decompression is performed through direct access to the spine:

• anterior (pretracheal) – in case of injury to the cervical spine;
• anterolateral (retroperitoneal) – in case of damage to the lumbar vertebrae;
• lateral;
• rear

Vertebrae may be subject to:

• reposition - comparison of bone fragments;
• cornorectomy - removal of the vertebral body;
• laminectomy - removal of the arch or processes;
• discectomy - removal of intervertebral discs.

At the same time, normal innervation and blood supply to the affected area are restored. Once this is complete, the spine is stabilized with an autologous bone graft or metal implant. The wound is closed, the damaged area is fixed motionless.

Metal implants stabilize the spine after surgery

Video: surgery for a spinal fracture

Rehabilitation

The rehabilitation period after a spinal cord injury can last from several weeks to two years, depending on the extent of the damage. For successful recovery, it is necessary to maintain the relative integrity of the spinal cord - if it is completely interrupted, the regeneration process is impossible. In other cases, nerve cell growth occurs at a rate of about 1 mm per day. Rehabilitation procedures pursue the following goals:

• increased blood microcirculation in damaged areas;
• facilitating delivery medical supplies into areas of regeneration;
• stimulation of cell division;
• preventing muscle dystrophy;
• improvement of the patient’s psycho-emotional state.

Proper nutrition

The basis of rehabilitation is a stable regime and proper nutrition. The patient's diet should include:

• chondroprotectors (jelly, sea fish);
• protein products (meat, liver, eggs);
• vegetable fats (olive oil);
• fermented milk products (kefir, cottage cheese);
• vitamins:
  • A (carrots, pumpkin, spinach);
  • B (meat, milk, eggs);
  • C (citrus fruits, rose hips);
  • D (seafood, kefir, cheese).

Exercise therapy and massage

Therapeutic exercise and massage are aimed at relieving spasms, improving muscle trophism, activating tissue metabolism and increasing spinal mobility.

Exercises should be started by the patient when his condition is stable, immediately after the removal of restrictive structures (plaster, bandages, skeletal traction). Preliminary radiography of the damaged spine - required condition this stage.

Loads during exercise therapy increase in steps: the first two weeks are different with minimal effort, the next four are increased, during the last two exercises are performed standing.

An example complex is:

Massage is an ancient and effective method of rehabilitation for back injuries. Given the sensitivity of a weakened spine, such mechanical manipulations should be performed by a person with knowledge and experience in the field of manual therapy.

Other physiotherapy techniques for recovery after injury

In addition, a variety of physiotherapeutic techniques are widely used for the rehabilitation of the victim:

• hydrokinesitherapy - gymnastics in an aquatic environment;
• acupuncture - a combination of acupuncture techniques with exposure to weak electrical impulses;
• iontophoresis and electrophoresis - methods of delivering drugs to tissues directly through the skin;
• mechanotherapy - rehabilitation methods involving the use of simulators;
• electrical neurostimulation - restoration of nerve conduction using weak electrical impulses.

The aquatic environment creates supportive conditions for the damaged spine, thereby accelerating rehabilitation

The psychological discomfort that arises in the victim due to forced immobility and isolation is helped to overcome by an occupational therapist - a specialist who combines the features of a rehabilitation therapist, psychologist and teacher. It is his participation that can restore lost hope and good spirits to the patient, which in itself significantly speeds up recovery.

Video: Dr. Bubnovsky about rehabilitation after spinal cord injuries

Treatment prognosis and possible complications

The prognosis of treatment depends entirely on the extent of the damage. Minor injuries do not affect many cells. Lost nerve circuits are quickly compensated by loose connections, so that their restoration occurs quickly and without consequences. Extensive organic damage is life-threatening to the victim from the first moment of its existence, and the prognosis for their treatment is ambiguous or completely disappointing.

The risk of complications increases greatly without the necessary assistance medical care as soon as possible.

Extensive damage to the spinal cord threatens many consequences:

• disruption of nerve fiber conduction due to rupture or hemorrhage (hematomyelia):
  • spinal shock;
  • violation of thermoregulation;
  • excessive sweating;
  • loss of sensation;
  • paresis;
  • paralysis;
  • necrosis;
  • trophic ulcers;
  • hemorrhagic cystitis;
  • hard tissue swelling;
  • sexual dysfunction;
  • muscle atrophy;
• spinal cord infection:
  • epiduritis;
  • meningomyelitis;
  • arachnoiditis;
  • abscess.

Prevention

There are no specific measures to prevent spinal cord injuries. You can simply limit yourself to caring for your body, maintaining it in proper physical fitness, avoiding excessive physical exertion, shocks, shocks, collisions. Routine examinations by a general practitioner will help identify hidden pathologies, health threatening backs.

Spinal cord diseases always require urgent treatment. Moreover, you only need to contact doctors; no independent treatment is acceptable! After all, any disease of the spinal cord is fraught with complications such as paralysis or paresis, and in some cases even death. Therefore, any suspicion of a deep back injury or an inflammatory process should be a signal to call an ambulance. Doctors will prescribe treatment that will help maintain the victim’s quality of life in the future.

The spinal cord is part of the central nervous system. It supplies data and impulses to the brain. The main job of the spinal cord is to adequately transport the orders of the brain to internal organs and muscles. It contains a variety of nerve tissue, signaling from the brain to the body and back.

The spinal cord consists of white and gray tissue, nerves and the cells themselves. In the middle of the spinal cord, in the many nerves, there is pure nerve tissue.

If pathologies or traumatic effects involve the spinal region, this can result in a great danger to normal functioning and the quality of a person’s life. In addition, there is a risk of death. Even small compressions, caused for example, can reduce sensitivity and mobility and negatively affect the functioning of internal organs. There are a huge number of symptoms of such disorders, but one thing remains unchanged - damage and disease in the area of ​​the spinal canal are noticeable immediately.

Symptoms

Mild manifestations of pathological processes include dizziness, pain, and increased blood pressure. Pain and other symptoms may not always appear the same. They may come in fits and starts, or they may gradually become stronger and weaker. They can also be chronic. It depends on the clinical picture and its details. In addition to pain pathological changes spine is often caused by:

• Decreased sensitivity and mobility;
• Urinary and fecal incontinence;
• Paralysis and paresis, complete and partial;
• Atrophic changes in muscles.

If something puts pressure on the spinal cord, a wide range of neurological problems can result. If the contents of the spinal canal change their position, or pressure is simply put on it, negative changes begin to occur in the body. Sometimes irreversible, and among other things the brain can be affected.

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If purulent and inflammatory processes occur, their foci often begin to put pressure on the spinal cord. This happens in many cases due to some third-party infectious diseases. The spine is well supplied with blood and is quite vulnerable to various infectious pathogens. Inflammation or suppuration can form here, which will pinch the nerve roots or begin to put pressure on the spinal cord, causing inevitable pain.

At intervertebral disc bulges back. Ultimately damaged cartilage tissue can begin to put pressure on the spinal cord, causing severe pain and neurological problems.

Spinal canal stenosis

Due to friction against each other, the vertebrae can build up osteophytes, sharp edges along their edges. If such growths become too large, there is a danger to the life and health of the patient. Also, the space in which the spinal cord is located may narrow due to changes in the position of the vertebrae, protrusions and hernial formations. To free the spinal cord, doctors often come to the conclusion that the only acceptable way to solve the problem is surgery.

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Tumors

New growths may develop in the area close to the spinal cord. Such as a cyst or malignant tumor. Also if cancer affected internal organs (for example, genitourinary system), metastases can penetrate into the vertebrae and spinal canal.

Myelopathy

When the spinal cord tissue begins to swell rapidly. Doctors do not always immediately detect the cause of the pathological process. Sometimes even the information obtained from magnetic resonance imaging may not paint the full picture.

This usually happens due to the fact that a malignant neoplasm develops in the lungs or chest. Such swelling is difficult to cure, and its symptoms quickly include difficulty moving, urinary and fecal incontinence. In cases where doctors did not immediately pay attention to myelopathy and did not prescribe adequate treatment, death may occur.

Diseases such as sinusitis can also cause rapid development of swelling. This myelopathy occurs acutely and is infectious in nature.

Spinal cord diseases often result in the blood supply to the spinal cord being impaired and it begins to starve. Cells begin to die and necrosis begins. The reason usually lies in traumatic effects on the spine. If there was already a herniated disc, it may rupture and its particles may spread inside the spinal canal. This may be one of the causes of spinal starvation.

The clinical picture is as follows:

• Sudden onset of weakness, “knocks you down”;
• Be sick;
• Body temperature decreases;
• Severe headache;
• The patient becomes faint or even loses consciousness.

If medical help arrives on time, specialists will be able to prevent death. But most likely, mobility impairments will remain to one degree or another for life.

Spinal blood circulation may be impaired due to various reasons. Sometimes these are genetically determined features of the vascular system. The symptoms of a spinal infarction include a large number of manifestations, which depend on what kind. If the spinal anterior artery has been compressed, tissue in the front of the spinal canal will begin to die. The patient will almost immediately begin to suffer from dysfunction of the pelvic organs, and the sensitivity of the legs will worsen. If such an artery is located in the neck area, sensitivity will decrease upper limbs, the temperature will rise. Again, the person may lose control of bowel movements and urination.

When a disease, no matter what, affects the spinal cord, the manifestations are immediate. Sensation below the affected area is immediately impaired. After all, these organs and muscles now perceive brain signals worse. This phenomenon may be accompanied by a sensation of “pins and needles” and weakness in the corresponding area. It's called paresthesia.

Although this deteriorates a person’s control over pelvic organs. It may also happen that instead of urinary incontinence, both the urge and the need to urinate disappear. This condition is dangerous because it accumulates substances that are toxic to the body.

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If the nerve fibers of the spinal cord are torn, the victim’s muscles a short time may cause severe spasm, tendon reflexes increase. The main manifestation is pain. It differs from pain, say, with a hernia in that it is clearly localized in the middle of the back, exactly along the line of the spine. The symptom will be life-threatening complete failure in the functioning of the rectum and bladder. In this case, the pain will radiate to the femoral and groin area.

No attempts self-treatment unacceptable. Even a qualified doctor has the right to prescribe medications after diagnosis.

As a rule, time is of the essence, and as soon as doctors begin working with the patient, they simultaneously move on to medical care and history taking.

To improve blood circulation in the spinal cord and prevent necrotic tissue death, agents such as a nicotinic acid or Cavinton. Because bladder may refuse to work, diuretics are prescribed. Thin the blood with aspirin or other similar medications, especially if blood clots are present.

After acute period ended and the doctors no longer worry about the patient’s life, the rehabilitation period begins. To restore tissue mobility and sensitivity, physiotherapy, exercise therapy, and massage procedures are used. In addition, it will be necessary to improve the passage of impulses through the nerves. Sometimes medications from the group of muscle relaxants are used to minimize unnecessary muscle spasms.

Surgical intervention is necessary for hernias, compression fractures, sometimes – changes in the position of the vertebrae. These conditions themselves do not relate to vascular pathologies of the back, but they often result in a lack of nutrition in the spinal canal. When inflammation during abscesses begins to affect the spinal cord area, it is urgently incised and the contents are pumped out so that purulent accumulations do not affect the nerve tissue.