Spinal cord injury: treatment and rehabilitation. Injuries to the spine and spinal cord Injury to the spinal cord in the lumbar region

It is the most dangerous for human life. It is accompanied by many complications and long-term rehabilitation. Injury to the spine threatens with disability and death. Most unwanted damage cervical. Treatment should begin as early as possible with emergency care, inpatient therapy and recovery course.

Damage spinal cord happens for the following reasons:

• in road traffic accidents, various injuries occur (bruises, fractures, dislocations, contusion different departments spine);
• falling from height;
• extreme sports (diving, skydiving);
• domestic, industrial injuries;
• gunshot, stab wounds;
• environmental disasters (earthquakes);
• non-traumatic disease disease (cancer, arthritis, inflammation)
• severe injury.

As a result of injury, fractures, vertebral arches, dislocations and displacements, ruptures and sprains, compression, concussion of the spinal cord occur. Damage is divided into closed and open, with or without violation of the integrity of the brain.

Traumatic factors cause pain, swelling, hemorrhage and spinal deformity. General symptoms: loss of consciousness, malfunction of organs (heart, lungs), paralysis, impaired thermoregulation of the body, the occurrence of a shock state, weakness in the muscles, numbness of the limbs, concussion, headache, nausea.

Spinal cord contusion manifests itself as a violation of all types of sensitivity. There is a decrease, loss of sensitivity, numbness of the skin, a feeling of goosebumps. If the symptoms are getting worse surgical intervention(when squeezing the brain, hematoma, bone fragments).

Spinal cord injury can cause visceral-vegetative disorders. These include dysfunction of the pelvic organs, gastrointestinal tract (increase or decrease in the formation of digestive enzymes), decreased blood circulation and lymphatic drainage in tissues.

Cervical injuries

They are the most dangerous and more often than other injuries lead to death. This is due to the fact that the centers of respiration and heartbeat are located in the medulla oblongata; in case of damage, the work of these centers stops. There are fractures of the cervical spine during sports, falls, accidents. In the case of a fracture of the upper vertebrae, death occurs in 30-40%. When the atlas is dislocated, headache, tinnitus, cramps of the upper limbs, sleep disturbance, and back pain occur.

If the cervical spine is injured at the level of C1-C4, dizziness, pain in the upper neck, aphonia, paresis, paralysis, disturbances in the work of the heart, dysphagia, and lack of sensitivity may occur. With dislocation of the C1-C4 vertebrae, radiating pains, difficulty swallowing, and a feeling of swelling of the tongue also occur.

If there is a fracture or dislocation of the two upper vertebrae, radicular syndrome manifests itself in 25% - pain in the back of the head and neck, partial impairment of brain function (manifested by severe pain in the arms, weakness in the legs). In 30%, a symptom of transverse brain damage is manifested in the form of spinal shock (reflexes are absent, sensitivity is lost, the functioning of organs is disrupted).

Spinal shock can be reversible or irreversible. Usually, after the restoration of damaged tissues, the functions return. Allocate acute stage shock (the first 5 days), during which the conduction of impulses stops, there is no sensitivity, reflexes. The subacute stage lasts up to 4 weeks, damaged tissues are restored, cicatricial changes are formed, blood circulation and cerebrospinal fluid movements return to normal. The interim period lasts from 3 to 6 months, there is a restoration of lost functions.

In case of trauma of the cervical spine: fractures, dislocations of the middle and lower cervical vertebrae, cerebral edema, impaired circulation of cerebrospinal fluid, hemorrhages, and hematomas may occur.

Injury to the thoracic and lumbar spine

Symptoms of damage to this department are paralysis of various muscle groups: intercostal (respiratory disorders occur), muscles of the abdominal wall, lower extremities. There is weakness in the legs, a disorder in the functioning of the pelvic organs, sensitivity decreases below the site of injury.

Diagnostics

For diagnosis and diagnosis, it is necessary to conduct a number of studies:

• Radiography is performed for all people with suspected damage, done at least in two projections;
• Computed tomography is a more accurate research method, provides information on various pathologies, reproduces cross-sectional images of the spine and brain;
• Magnetic resonance imaging will help to reveal the smallest details in case of damage (blood clots, splinters, hernia);
• Myelography allows you to accurately see all the nerve endings, which is necessary for proper diagnosis, it can detect the presence of a hematoma, hernia, tumor;
• Vertebral angiography is performed to visualize the vessels of the spine. Check the integrity of the vessels, determine the presence of hemorrhages, hematomas;
• A lumbar puncture is performed to analyze the cerebrospinal fluid. May detect blood, infection, foreign bodies in the spinal canal.
• When making a diagnosis, consider the cause of the injury, the severity clinical symptoms, the effectiveness of first aid, the results of the examination and research methods.

Provision of emergency medical care

• it is necessary to limit mobility: place the victim on a hard surface, fix the injured area;
• prevent further damage to the body;
• if necessary, introduce painkillers;
• control breathing and pulse;
• when diagnosing shock, remove the patient from this state.

When transporting the patient, they try to avoid deformation of the spine so as not to cause further damage. AT medical institution it is necessary to place the victim on a hard bed or a shield on which bed linen is pulled. The use of the Stricker frame is effective, it provides immobilization and patient care. Further, with the help of orthopedic treatment, deformities are eliminated, fixed, and a stable position of the spine is ensured.

Treatment

Orthopedic treatments include: reduction of fractures, dislocations, traction, long-term immobilization of the spine. In case of damage to the cervical spine, it is recommended to wear a neck brace.

Surgical treatment consists of removing foreign bodies, eliminating pressure on tissues and blood vessels, correcting deformities, restoring the anatomy of the spinal canal and brain, and stabilizing the damaged area.

If surgical treatment is necessary for spinal cord injury, the operation is performed urgently. 6-8 hours after damage, irreversible changes may occur. For surgical intervention, all contraindications are eliminated with the help of intensive therapy. Optimize cardiovascular and respiratory system, eliminate cerebral edema, prevent infections.

Medical treatment involves the appointment medicines. They use painkillers, hemostatic, anti-inflammatory drugs, stimulate an increase in immunity and body resistance. With spinal shock, atropine, dopamine, large doses of the hormone methylprednisolone are used. Hormone therapy (dexamethasone, prednisolone) reduces swelling of the nervous tissue, inflammation, and pain. With pathological muscle spasticity, centrally acting muscle relaxants (mydocalm, baclofen) are used. Broad-spectrum antibiotics are used to treat or prevent the occurrence of infectious diseases.

With spinal cord injury, hormones are contraindicated in individual sensitivity, hormone therapy increases the risk of blood clots.

Effective is the use of physiotherapy treatment. Carry out therapeutic massage, electrophoresis, electromyostimulation and biostimulation of body parts with reduced or lost sensitivity. Carry out applications with paraffin and various water procedures.

Complications

Immediately upon injury, bleeding, hematomas, ischemia, a sharp decrease in pressure, the occurrence of spinal shock, and CSF leakage occur.

After a spinal injury, there is a risk of various complications: bedsores, muscle spasticity, autonomic dysreflexia, difficulty with urination and emptying, sexual dysfunction. There may be pain in the area of ​​reduced or lost sensitivity. While caring for the sick, it is necessary to rub the skin, do exercises for the limbs, and help with bowel cleansing.

Rehabilitation

Life after a spinal cord injury can become significantly limited. To restore lost functions, it is necessary to undergo a long rehabilitation, physiotherapists will help restore the strength of the arms and legs, and teach how to perform household tasks. The patient will be taught how to use equipment for the disabled (wheelchair, toilet). Sometimes it is necessary to change the design of the house to create conditions for the patient and facilitate self-care. Modern wheelchairs make life easier for patients.

Medical rehabilitation of people with spinal cord injury involves hormone therapy, with chronic pain - painkillers, muscle relaxants, medicines to improve bowel function, Bladder, genitals.

Spinal injuries have always been considered the most dangerous, since they cause not only ruptures of muscles, tendons, dislocations and fractures of the vertebrae, but also possible damage to the spinal cord. This can happen due to the instantaneous and abrupt application of dynamic force in one direction or another, as happens, for example, in accidents and falls. In case of an accident, secondary damage to the spinal cord is more often observed, which manifests itself as a complication after a spinal injury.

Represents the greatest threat of all possible misfortunes that can happen to the spine, since its narrowness in this area can lead to impaired conduction of the spinal cord. Trauma treatment should be immediate and mobile.

Cervical spine injury

The most frequent injuries of the cervical spine occur during diving, the second "honorable" place is occupied by road accidents, and the third - by falls from a height.

According to the direction of the effort, traumatic injuries are divided into the following:

• Flexion
• extensor
• Flexion-rotational
• Vertically squeezing
• Lateral flexion
• Indefinite direction

• dislocations and subluxations of the atlas
• fractures and dislocations
• vertebral displacement
• spinous process fractures
• fracture of the second cervical vertebra
• ruptured intervertebral discs
• compression fractures and other injuries

Any injury to the spine is dangerous because it can lead to complications:

1. Edema of the spinal cord
2. Hemorrhage and hematomas
3. ischemia
4. Falling blood pressure
5. Violation of blood flow and movement of cerebrospinal fluid

In this case, we speak of a complicated injury. For the cervical region, such consequences can be deplorable and lead to death, so it is important to start treatment from the very first minutes. Within a few hours, irreversible changes in the white matter of the brain and necrosis of individual areas may occur.

Symptoms of injuries of the cervical spine

With a cervical bruise, symptoms of damage to the nerve fibers and myelopathic syndromes caused by compression of the spinal cord:

• pain in the neck with the slightest change in the position of the neck, radiating to the back of the head, shoulders, shoulder blades, arms
• loss of sensation and motor activity
• pelvic dysfunction

Damage to the spinal cord can lead to complete or partial impairment of brain conduction:

Symptoms of complete failure:

• The disappearance of absolutely all motor reflexes and loss of sensitivity in all areas of the body located below the point of damage
• Delayed or involuntary urination and defecation

Symptoms with partial violation:

• Some reflexes and the ability to move below the injury site are partially preserved, as is local sensitivity. The patient can make separate movements, responds to the capture of skin-muscle folds

Complete loss of conductivity occurs when:

• Rupture of the spinal cord - in this case, its full recovery is hardly possible
• Spinal shock (complete inhibition of all reflexes) - after a while, conductivity is restored

Neurological syndromes in myelopathy in the cervical segments

If the spinal cord is damaged at the level of the upper vertebrae of the cervical spine C1-C4 the following symptoms are observed:

• flaccid and spastic paralysis of all four limbs (tetraparesis and tetraplegia)
• respiratory failure (possible paralysis)
• vertigo (dizziness)
• dysphagia (inability to swallow)
• aphonia (difficulty speaking)
• slow heart rate
• pain and temperature insensitivity syndrome (with unilateral brain damage)

In case of damage to the brain of the lower part of the cervical region C5 - C7 and in the first thoracic vertebra Th1 the symptoms are:

• Peripheral paraparesis of the upper limbs and paraplegia of the lower
• Pupil constriction, colorless iris and retraction eyeball (Claude Bernard-Horner syndrome)

Spinal Cord Conductivity Scale

AT modern medicine There are two options for classifying spinal cord injuries on a scale Frenkel.

The modern version of the Frenkel scale includes five degrees of conduction disturbance:

• A-full
• B, C and D- incomplete
• E- norm

The system for assessing muscle strength on this scale is 5 points.

Symptoms corresponding to each degree of conduction disturbance:

• A. Absence of any movement and sensation in the vertebrae S4 - S5 of the sacral spine
• b. Preservation of only sensitivity, but not motor ability, below the level of damage and also in the segment S4 - S5
• C. Muscle motor strength below the affected level is less than 3 points
• D. Muscle strength is equal to or greater than 3 points
• E. Functions of the movement and sensitivity are not broken. Muscle strength 5 points or more

This scale allows you to evaluate the prognosis for the restoration of conductivity after a month from the moment of injury:

• If the sum of the points of the muscles of a certain group, for example, the lower limbs, is such that each pair of muscles accounts for more than 3 points, then the forecast that the patient will learn to walk by the end of the year, at least with the help of crutches, is very high.
• If, at the end of the month, muscle activity is near zero, then, unfortunately, the possibility of recovery in the future is also small.

Treatment of injuries of the cervical spine

After a spinal injury has occurred, relatives, friends or simply witnesses of the incident are obliged to call ambulance, even if no special damage is noticed on the surface of the neck, and the victim declares that he is in perfect order. What first aid should be provided by emergency and emergency room doctors?

First aid emergency

First aid for a patient with a cervical spine injury further treatment must be extraordinary. The account can go for minutes. The doctor must be prepared for a sudden drop in blood pressure, respiratory arrest, post-traumatic complications

1. First, all external injuries (bruises and abrasions) should be considered in order to determine the location, strength and direction of the traumatic load. The absence of external signs of damage does not mean anything
2. Gently transfer the patient to the shield
3. Produce immobilization(immobilization) of the injured neck with or Shants collar, which can be made independently according to the height of the victim's neck from flexible cardboard and gauze (the front height of the collar is always greater than the back) The immobility of the cervical spine is needed not only to save from pain. Vertebral injuries are comminuted, and then careless movement of the neck can lead to rupture of the vertebral artery and death
4. Test pupils and eyeballs
5. measure arterial pressure and check your pulse
6. Ask the patient about his painful sensations, to palpate the body below the level of injury
7. Perform primary x-ray examination of the cervical region in lateral projection

Conservative treatment of cervical spine injury

1. At least three are made x-ray: in direct, lateral projections and through the mouth
2. If necessary, a detailed computer research to determine the nature of damage to the vertebrae
3. If there are signs of damage to the spinal cord, magnetic resonance imaging is done to identify damaged segments
4. With a strong pain shock - make a blockade using novocaine and hydrocortisone, preferably inside the damaged disc of the spine.
   This procedure is not easy: the introduction of the needle is carried out under control spondylography
5. Blood pressure and circulation are controlled. At respiratory failure the patient is connected to the ventilator
6. An increase in pressure contributes to a more favorable and fast treatment spinal cord and accelerates recovery from spinal shock
7. When urination is disturbed, a catheter is inserted into the urinary canal
8. If swelling of the spinal cord occurs, excess fluid is removed from the body - intercellular and cerebrospinal fluid.
   Intracranial hypertension, which accompanies edema, leads to increased intracranial pressure, which is manifested by severe bursting headaches. Treatment of edema and hypertension is carried out: by removing excess liquor, with help diuretics
9. Treatment of a cervical injury also includes the following medications: antirheumatic,Vitamins B1, B2 and C,A nicotinic acid, In a non-acute period, in the absence of infectious inflammatory processes, to reduce pain at the site of injury, you can use electrophoresis with novocaine

In case of minor injuries, without damage to the spine and spinal cord, such as sprain or rupture of the neck ligaments, for example, such conservative treatment:

1. Taking painkillers
2. Traffic restriction mode
3. Therapeutic exercise with gentle loads
4. Physiotherapy procedures

To eliminate dislocations and displacements resulting from trauma, produce orthopedic treatment ( hood) or an operation.

Cervical traction

Cervical traction is performed in an inclined position or sitting. It can be done in several ways:

Over the head with Glisson loops:
.
This method has hardly been used recently due to trophic disorders of the facial muscles as a result of facial compression.

For the tubercles of the parietal part of the head:

• Advantages of the method: the possibility of using large loads and achieving a good result of stretching
• Disadvantage: unreliable fastening of the bracket and pins, the possibility of excessive stretching of the spinal cord

With the help of a special Halo-device:
.
The ring is attached to the skull with clamps and attached to a corset worn on the cervical region.

• With the help of the Halo-device, the extraction is more accurate, it is possible to produce dosed necessary loads
• There is a danger of an inflammatory process in the cranium, in the places where the clamps are attached

After stretching, a plaster cast is applied to the neck. thoracocranial bandage for three months. After removing the bandage for two weeks put on Shants collar.

Cervical traction is also performed at the initial stage of operations to remove the consequences of an injury.

Surgical treatment of cervical injury

Surgical treatment is resorted to:

• when squeezing the spinal cord and nerve roots, threatening serious neurological disorders now and in the future
• with a decrease in the height of the vertebra by more than half
• cervical kyphosis more than 11 ̊
• anterior-posterior displacement of the vertebra more than 3.5 mm
• severe deformity and pain

Operations are of three types:

• With posterior surgical access
• Anterior surgical approach
• Mixed type (use both accesses)

Anterior surgical approach is preferred for spinal cord decompression

The main method used by surgeons in the treatment of vertebral injuries is spinal fusion:

After restoration, the damaged vertebra or segment is fixedly connected to the neighboring one.

The operation can have two or three technical steps:

1. Reduction of the vertebrae and discs with the help of a hood
2. Removal of fragments in damaged segments in comminuted injuries
3. Reconstruction of a damaged vertebra or disc (for example, an iliac crest graft is inserted in place of a collapsed disc)

Postoperative complications and its treatment

Surgery on the cervical spine is often complicated by such phenomena:

• instability of the injury, that is, a large area of ​​damage that requires additional fixation
• the ability to move the cervical graft
• risk of neurological complications

Therefore, to avoid such complications in neck surgery, external fixation is often used with a Halo device or a thoracocranial dressing applied for up to four months.

After the operation, such complications are also very frequent, due to which the treatment is delayed:

1. Danger of blood clots
2. Diseases of the stomach and intestines
3. Trophic ulcers
4. Pulmonary complications
5. Urological diseases

Treatment of postoperative complications includes:

• taking antibiotics
• vasodilators
• neuroprotectors

Active rehabilitation after injury

Prolonged wearing of plaster bandages and collars leads to muscle-tendon contractures. This is the main obstacle that prevents the patient from learning to move as before.

To develop long-term immobilized muscles and tendons, active rehabilitation is carried out:

1. Biomechanical stimulation
2. Special therapeutic exercises prescribed by a doctor: performed at home and on simulators
3. Hardware physiotherapy: high-frequency pulses on the device Darsonval,electrical stimulation,laser and magnetic therapy
4. Ozokerite and paraffin applications
5. Massage
6. Swimming

The duration of active rehabilitation is approximately equal to the duration of immobilization

This means: if you carried a plaster cast or corset for three months, then the restoration of motor activity should last no less.

Brief conclusions:

Thus, the treatment of an injury to the cervical spine depends on its severity:

1. It may be limited to immobilization and rest for several days - in the absence of damage.
2. When ligaments are torn - can take place in the form of conservative treatment from 2 to more weeks
3. For more serious spinal injuries, with damage to the vertebrae or discs, an extraction is performed and, possibly, an operation, after which there is a rehabilitation period of 3-4 months
4. Finally, a complicated injury of the cervical spine with spinal cord injury and conduction disturbance requires a long-term multi-stage treatment, including: Elimination of complications in the spinal cord (edema, hemorrhage). Sometimes a neurosurgical operation to restore the conduction of the spinal cord, if there is no complete rupture, or the possibility of a partial return of sensitivity through the connection of the spinal nerves remains. conservative or surgery cervical spine injuries. Active rehabilitation

Causes of emergencies in spinal lesions may be traumatic or non-traumatic.

To non-traumatic reasons include:

• Medullary processes:
  • spinal cord inflammation: myelitis, viral and autoimmune
  • medullary tumors (gliomas, ependymomas, sarcomas, lipomas, lymphomas, drip metastases); paraneoplastic myelopathy (eg, in bronchial carcinoma and Hodgkin's disease)
  • radiation myelopathy in the form of acute, from incomplete to complete, symptoms of lesions at a certain level of the spinal cord at radiation doses of 20 Gy with a latency of several weeks to months and years
  • vascular spinal syndromes: spinal ischemia (eg, after aortic surgery or aortic dissection), vasculitis, embolism (eg, decompression sickness), vascular compression (eg, due to mass effect), and spinal arteriovenous malformations, angiomas, cavernomas, or dural fistulas ( with venous stasis and congestive ischemia or hemorrhage)
  • metabolic myelopathy (with acute and subacute course); funicular myelosis with vitamin B 12 deficiency; hepatic myelopathy in liver failure
• Extramedullary processes:
  • purulent (bacterial) spondylodiscitis, tuberculous spondylitis (Pott's disease), mycotic spondylitis, epi- or subdural abscess;
  • chronic inflammatory rheumatic diseases of the spine such as rheumatoid arthritis, seronegative spondyloarthropathy (ankylosing spondylitis), psoriatic arthropathy, enteropathic arthropathy, reactive spondyloarthropathy, Reiter's disease;
  • extramedullary tumors (neurinomas, meningiomas, angiomas, sarcomas) and metastases (eg, bronchial cancer, multiple myeloma [plasmocytoma]);
  • spinal subdural and epidural hemorrhages in blood clotting disorders (anticoagulation!), condition after injury, lumbar puncture, epidural catheter and vascular malformations;
  • degenerative diseases such as osteoporotic fractures of the spine, spinal canal stenosis, herniated discs.

To traumatic reasons include:

• Contusion, infringement of the spinal cord
• Traumatic hemorrhages
• Fracture/dislocation of the vertebral body

Non-traumatic spinal cord injuries

Inflammation/infection of the spinal cord

Frequent causes of acute myelitis are primarily multiple sclerosis and viral inflammations; however, pathogens are not detected in more than 50% of cases.

Risk factors for spinal infection are:

• Immunosuppression (HIV, immunosuppressive drug therapy)
• Diabetes
• Alcohol and drug abuse
• Injuries
• Chronic diseases of the liver and kidneys.

Against the background of a systemic infection (sepsis, endocarditis), especially in these risk groups, additional spinal manifestations of infection may also be noted.

spinal ischemia

Spinal ischemia, compared with cerebral ischemia, is rare. In this regard, a favorable effect is exerted, first of all, by good collateralization of the blood flow of the spinal cord.

The following are considered as causes of spinal ischemia:

• Arteriosclerosis
• aortic aneurysm
• Operations on the aorta
• Arterial hypotension
• Obstruction/dissection of the vertebral artery
• Vasculitis
• Collagenosis
• Embolic vascular occlusion (eg, decompression sickness in divers)
• Spinal volumetric processes (intervertebral discs, tumor, abscess) with vascular compression.

In addition, there are also idiopathic spinal ischemias.

Tumors of the spinal cord

According to anatomical localization, spinal tumors/volume processes are subdivided into:

• Vertebral or extradural tumors (eg, metastases, lymphomas, multiple myeloma, schwannomas)
• Tumors of the spinal cord (spinal astrocytoma, ependymoma, intradural metastases, hydromyelia/syringomyelia, spinal arachnoid cysts).

Hemorrhage and vascular malformations

Depending on the compartments, there are:

• epidural hematoma
• subdural hematoma
• Spinal subarachnoid hemorrhage
• Hematomyelia.

Spinal hemorrhages are rare.

The reasons are:

• Diagnostic/therapeutic measures such as lumbar puncture or epidural catheter
• Oral anticoagulation
• Blood clotting disorders
• Malformations of the spinal vessels
• Injuries
• Tumors
• Vasculitis
• Manual therapy
• Rarely, aneurysms in the cervical region (vertebral artery)

Vascular malformations include:

• Dural arteriovenous fistulas
• Arteriovenous malformations
• Cavernous malformations and
• spinal angiomas.

Symptoms and signs of non-traumatic spinal cord injuries

Clinical picture in spinal emergencies depends mainly on the underlying etiopathogenesis and localization of the lesion. These conditions typically present with acute or subacute neurological deficits, which include:

• Sensitization disorders (hypesthesia, par- and dysesthesia, hyperpathia) usually caudal to spinal cord injury
• Motor deficits
• Vegetative disorders.

The phenomena of prolapse can be lateralized, but they also appear in the form acute symptoms transverse spinal cord injury.

ascending myelitis can lead to damage to the brainstem with cranial nerve prolapse and dative insufficiency, which may clinically correspond to the pattern of Landry's palsy (= ascending flaccid paralysis).

Back pain, often drawing, stabbing, or blunt, felt primarily with extramedullary inflammatory processes.

With local inflammation fever may initially be absent and develops only after hematogenous dissemination.

spinal tumors initially often accompanied by back pain, which is aggravated by percussion of the spine or during exercise, neurological deficits do not have to be present. Radicular pain can occur with damage to the nerve roots.

Symptoms spinal ischemia develops over a period of minutes to hours and, as a rule, covers the pool of the vessel:

• Syndrome of the anterior spinal artery: often radicular or girdle pain, flaccid tetra- or paraparesis, lack of pain and temperature sensitivity while maintaining vibration sensitivity and joint-muscular feeling
• Sulco-commissural artery syndrome
• Posterior spinal artery syndrome: loss of proprioception with ataxia when standing and walking, sometimes paresis, bladder dysfunction.

Spinal hemorrhages are characterized by acute - often unilateral or radicular - back pain, usually with incomplete symptomatology of the transverse spinal cord lesion.

Due to malformations of the spinal vessels often slowly progressing symptoms of transverse lesions of the spinal cord develop, sometimes fluctuating or paroxysmal.

At metabolic disorders it is necessary, first of all, to remember the deficiency of vitamin B12 with a picture of funicular myelosis. It often presents in patients with pernicious anemia (eg, Crohn's disease, celiac disease, malnutrition, a strict vegetarian diet) and slowly progressive motor deficits, such as spastic paraparesis and gait disturbances, and sensory deficits (paresthesias, decreased vibration sensitivity). ). Additionally, cognitive functions usually worsen (confused consciousness, psychomotor retardation, depression, psychotic behavior). Rarely, with impaired liver function (mainly in patients with a portosystemic shunt), hepatic myelopathy develops with damage to the pyramidal tract.

Polio classically proceeds in several stages and begins with a fever, followed by a meningitis stage until the development of a paralytic stage.

spinal syphilis with tabes of the spinal cord (myelitis of the posterior / lateral funiculi of the spinal cord) as a late stage of neurosyphilis, it is accompanied by progressive paralysis, sensory disturbances, stabbing or cutting pains, loss of reflexes and impaired bladder function.

Myelitis at tick-borne encephalitis often associated with "severe transverse symptomatology" involving the upper extremities, cranial nerves, and diaphragm, and has a poor prognosis.

Optic neuromyelitis(Devic's syndrome) is autoimmune disease that predominantly affects young women. It is characterized by signs of acute (transverse) myelitis and optic neuritis.

Radiation myelopathy develops after irradiation, as a rule, with a latency of several weeks to months and may present with acute spinal symptoms (paresis, sensory disturbances). The diagnosis is indicated by the history, including the size of the radiation field.

Diagnosis of non-traumatic spinal cord injuries

Clinical examination

Localization of damage is established by the study of sensitive dermatomes, myotomes and stretch reflexes of skeletal muscles. The study of vibration sensitivity, including the spinous processes, helps in determining the level of localization.

Autonomic disorders can be identified, for example, through the tone of the anal sphincter and impaired bladder emptying with the formation of residual urine or incontinence. Limited inflammation of the spine and adjacent structures is often accompanied by pain on tapping and squeezing.

Symptoms of spinal inflammation at first can be completely non-specific, which significantly complicates and slows down the diagnosis.

Difficulties arise in the differentiation caused by the pathogen and parainfectious myelitis. In the latter case, an asymptomatic interval between a previous infection and myelitis is often described.

Visualization

If a spinal process is suspected, the method of choice is MRI in at least two projections (sagittal + 33 axial).

Spinal ischemia, inflammatory foci, metabolic changes and tumors especially well visualized on T2-weighted images. Inflammatory or edematous changes, as well as tumors, are well displayed in STIR sequences. After the injection of a contrast agent in T1 sequences, blooming inflammatory foci and tumors are usually well differentiated (sometimes subtractions of the original T1 from T1 after the injection of a contrast agent for more accurate delimitation of the contrast). If bone involvement is suspected, T2 or STIR sequences with fat saturation, or T1 after contrast agent injection, are appropriate for better differentiation.

Spinal hemorrhages can be recognized on CT in case of emergency diagnosis. However, MRI is the method of choice for better anatomical and etiological classification. Hemorrhages on MRI are displayed differently, depending on their stage (< 24 часов, 1-3 дня и >3 days). If there are contraindications to MRI, then to assess bone damage and clarify the issue of significant mass effects in extramedullary inflammatory processes, CT of the spine with contrast is performed.

To minimize the dose of radiation received by the patient, it is advisable to determine the level of damage on the basis of the clinical picture.

In rare cases (functional imaging, intradural volume processes with bone involvement), it is advisable to perform myelography with postmyelographic computed tomography.

Degenerative changes, fractures and osteolysis of the vertebral bodies can often be recognized on a plain x-ray.

Liquor research

An important role is played by cytological, chemical, bacteriological and immunological analysis of CSF.

Bacterial inflammation usually accompanied by marked increases in cell count (> 1000 cells) and total protein. If a bacterial infection is suspected, it is necessary to strive to isolate the pathogen by sowing cerebrospinal fluid on the flora or by PCR. With signs of systemic inflammation, the bacterial pathogen is detected by blood culture.

At viral inflammations, apart from a slight or moderate increase in the number (usually from 500 to a maximum of 1000 cells), there is usually only a slight increase in the level of proteins. On the viral infection may indicate the detection of specific antibodies (IgG and IgM) in the cerebrospinal fluid. The formation of antibodies in the CSF can be reliably confirmed by determining the avidity index of specific antibodies (AI). An index >1.5 is suspicious, and values ​​>2 indicate the formation of antibodies in the central nervous system.
Antigen detection by PCR is a fast and reliable method. This method can, in particular, give important information in the early phase of infection, when the humoral immune response is still insufficient. In autoimmune inflammation, there is a slight pleocytosis (< 100 клеток), а также нарушения гематоэнцефалического барьера и повышение уровня белков

In multiple sclerosis, more than 80% of patients have oligoclonal bands in the CSF. Optical neuromyelitis in more than 70% of patients is associated with the presence in the serum of specific antibodies to aquaporin 4.

Other diagnostic measures

Routine laboratory diagnostics, general analysis blood and C-reactive protein in the case of isolated inflammatory spinal processes do not always help, and often in the initial phase, no anomalies are found in the analyzes, or only minor changes are present. However, increasing the level C-reactive protein in bacterial spinal inflammation is a non-specific symptom that should lead to a detailed diagnosis.

Pathogens are identified by bacterial blood culture, sometimes by biopsy (CT-guided puncture for abscess or discitis) or intraoperative sampling.

Electrophysiological studies serve to diagnose functional damage nervous system and, above all, to assess the forecast.

Differential Diagnosis

Attention: such a phenomenon in the cerebrospinal fluid can occur with "cerebrospinal fluid blockade" (in the absence of cerebrospinal fluid flow as a result of mechanical displacement of the spinal canal).

Differential diagnosis of non-traumatic spinal injuries includes:

• Acute polyradiculitis (Guillain-Barré syndrome): acute "ascending" sensorimotor deficits; it is usually possible to differentiate myelitis on the basis of a typical cell-protein dissociation in the cerebrospinal fluid with an increase in total protein while maintaining a normal number of cells.
• Hyper- or hypokalemic paralysis;
• Syndromes with polyneuropathy: chronic inflammatory demyelinating polyneuropathy with acute deterioration, borreliosis, HIV infection, CMV infection;
• Myopathic syndromes (myasthenia gravis, dyskalemic paralysis, rhabdomyolysis, myositis, hypothyroidism): usually an increase in creatine kinase, and in dynamics - a typical EMG picture;
• Parasagittal cortical syndrome (eg, sickle brain tumor);
• Psychogenic symptoms of transverse lesions of the spinal cord.

Complications of emergencies in spinal lesions

• Prolonged sensorimotor deficits (paraparesis/paraplegia) with increased risk
  • deep vein thrombosis (thrombosis prevention)
  • contractures
  • spasticity
  • bedsores
• With high cervical injuries, the risk of respiratory disorders - increased risk of pneumonia, atelectasis
• Autonomic dysreflexia
• Impaired bladder function, increased risk of urinary tract infections up to urosepsis
• Impaired bowel function -» danger of excessive bloating, paralytic ileus
• Temperature regulation disorders in the case of lesions located at the level of 9-10 thoracic vertebrae with the risk of hyperthermia
• Increased risk of orthostatic hypotension

Treatment of non-traumatic spinal cord injuries

Inflammation of the spinal cord

In addition to specific therapy directed against the pathogen, general measures should first be carried out, such as the installation of a urinary catheter for violations of bladder emptying, prevention of thrombosis, changing the position of the patient, timely mobilization, physiotherapy and pain therapy.

General therapy: drug therapy depends mainly on the etiopathogenesis of the spinal lesion or on the pathogen. Often in the initial phase it is not possible to unambiguously establish the etiological affiliation or isolate pathogens, so the choice of drugs is carried out empirically, depending on the clinical course, the results laboratory diagnostics and research of cerebrospinal fluid, as well as from the expected spectrum of pathogens.

In the beginning, a broad combination antibiotic therapy should be carried out using an antibiotic that acts on the central nervous system.

In principle, antibiotics or virostatic agents should be used in a targeted manner.

The choice of drugs depends on the results of a study of bacteriological cultures of blood and cerebrospinal fluid or cerebrospinal fluid punctures (an angiogram is required!), As well as on the results of serological or immunological studies. In case of subacute or chronic course disease should, if the clinical situation allows it, first conduct a targeted diagnosis, if possible, with isolation of the pathogen, and, if necessary, differential diagnosis.

In bacterial abscesses, in addition to antibiotic therapy (if possible from an anatomical and functional point of view), the possibility should be discussed and taken individual solution about neurosurgical sanitation of the focus.

Specific therapy:

• idiopathic acute transverse myelitis. There are no placebo-controlled randomized trials that unequivocally support the use of cortisone therapy. Similar to the treatment of others inflammatory diseases and based on clinical experience, 3-5 days intravenous cortisone therapy with methylprednisolone 500-1000 mg is often given. Patients with a severe clinical condition may also benefit from more aggressive cyclophosphamide therapy and plasmapheresis.
• myelitis associated with herpes simplex and herpes zoster: acyclovir.
• CMV infections: ganciclovir. In rare cases of intolerance to acyclovir in HSV, varicella-zoster or CMV infections, foscarnet can also be used.
• neuroborreliosis: 2-3 weeks antibiosis with ceftriaxone (1x2 g/day IV) or cefotaxime (3x2 g/day IV).
• neurosyphilis: penicillin G or ceftriaxone 2-4 g/day intravenously (the duration of therapy depends on the stage of the disease).
• tuberculosis: multi-month four-component combination therapy with rifampicin, isoniazid, ethambutol and pyrazinamide.
• spinal abscesses with progressive neurological prolapse (eg, myelopathic signal on MRI) or pronounced signs of a volumetric process require urgent surgical intervention.
• spondylitis and spondylodiscitis are often treated conservatively with immobilization and (if possible targeted) antibiotic therapy for at least 2-4 weeks. Antibiotics that act well on the CNS for Gram-positive pathogens include, for example, fosfomycin, ceftriaxone, cefotaxime, meropenem and linezolid. In the case of tuberculous osteomyelitis, multi-month anti-tuberculosis combination therapy is indicated. In the absence of effect or severe symptoms, before
  In general, bone destruction with signs of instability and/or depression of the spinal cord may require surgical debridement with removal of the intervertebral disc and subsequent stabilization. Surgical measures should be discussed primarily in the case of compression of neural structures.
• - neurosarcoidosis, neuro-Behcet, lupus erythematosus: immunosuppressive therapy; depending on the severity of the disease, cortisone is used and, mainly in long-term therapy, also methotrexate, azathioprine, cyclosporine and cyclophosphamide.

spinal ischemia

Therapeutic options for spinal ischemia are limited. There are no evidence-based medicine recommendations. The restoration or improvement of the spinal circulation comes to the fore in order to prevent further damage. Accordingly, it is necessary, as far as possible, to therapeutically address the underlying causes of spinal ischemia.

In case of vascular occlusion, blood coagulation (anticoagulation, heparinization) should be taken into account. Administration of cortisone is not recommended due to potential side effects.

In the initial phase, the basis of therapy is the control and stabilization of vital functions, as well as the prevention of complications (infections, bedsores, contractures, etc.). In the future, neurorehabilitation measures are shown.

Tumors

In the case of isolated volumetric processes with compression of the spinal cord, urgent surgical decompression is necessary. The longer there is or continues spinal cord injury (>24 hours), the worse the chances of recovery. In the case of radiosensitive tumors or metastases, the possibility of irradiation is considered.

Other therapeutic options, depending on the type of tumor, its prevalence and clinical symptoms, include conservative therapy, radiation (including gamma knife), chemotherapy, thermocoagulation, embolization, vertebroplasty, and with signs of instability, various stabilization measures. Therapeutic Approaches should be discussed interdisciplinary, with neurologists, neurosurgeons/trauma surgeons/orthopedic oncologists (radiotherapy specialists).

For spinal volume processes with edema, cortisone is used (eg 100 mg hydrocortisone per day, according to the standards of the German Society of Neurology 2008, alternatively dexamethasone, eg 3 x 4-8 mg/day). The duration of treatment depends on the clinical course and/or changes in imaging data.

Spinal hemorrhages

Depending on the clinical course and volumetric nature of the process, sub- or epidural spinal hemorrhage may require surgical intervention (often decompressive laminectomy with blood aspiration).

With small hemorrhages without signs of a mass effect and with minor symptoms, conservative expectant management with control of the dynamics of the process is initially justified.

Spinal vascular malformations respond well to endovascular therapy (embolization). First of all, type I arteriovenous malformations (=fistulas) can often be occluded. Other arteriovenous malformations may not always be occluded, but can often be reduced in size.

Prognosis for non-traumatic spinal cord injuries

Prognostically unfavorable factors in inflammatory lesions of the spinal cord include:

• Initially rapidly progressive course
• Duration of neurological loss for more than three months
• Detection of protein 14-3-3 in CSF as a sign of neuronal damage
• Pathological motor and sensory evoked potentials, as well as signs of denervation on EMG.

Approximately 30-50% of patients with acute transverse myelitis have a poor outcome with residual severe disability, and the prognosis for multiple sclerosis is better than for patients with other causes of transverse spinal cord syndrome.

The prognosis of spondylitis/spondylodiscitis and spinal abscesses depends on the size and duration of damage to neural structures. The decisive factor is therefore timely diagnosis and therapy.

The prognosis of spinal ischemia, due to limited therapeutic options, is poor. Most patients have a persistent neurological deficit, depending mainly on the type of primary lesion.

The prognosis for spinal volumetric processes depends on the type of tumor, its prevalence, the scale and duration of damage to neural structures, and the possibilities or effect of therapy.

The prognosis of spinal hemorrhages is determined mainly by the severity and duration of neurological deficits. With small hemorrhages and conservative tactics, the prognosis in most cases can be favorable.

Traumatic spinal cord injury

Spinal injuries occur as a result of high-energy force impact. Common reasons include:

• high speed crash
• Fall from a great height and
• Direct force.

Depending on the accident mechanism, axial forces can lead to compression fractures of one or more vertebrae, as well as to flexion-extension injuries of the spine with distraction and rotational components.

Approximately 15-20% of patients with severe traumatic brain injury have concomitant injuries of the cervical spine. Approximately 15-30% of patients with polytrauma have spinal injuries. Fundamentally recognized is the allocation in the spine of the anterior, middle and posterior columns or column ( three-column model Denis), and the anterior and middle columns of the spine include the vertebral bodies, and the posterior - their dorsal segments.

A detailed description of the type of injury reflecting functional and prognostic criteria is classification of injuries of the thoracic and lumbar spine, according to which spinal injuries are divided into three main types A, B and C, where each of the categories includes three further subtypes and three subgroups. Instability increases in the direction from type A to type C and within the respective subgroups (from 1st to 3rd).

For injuries of the upper cervical spine, due to anatomical and biomechanical features, there is separate classification.

In addition to fractures, the following injuries occur with spinal injuries:

• Hemorrhages in the spinal cord
• Bruises and swelling of the spinal cord
• Spinal cord ischemia (due to compression or rupture of arteries)
• Ruptures, as well as displacement of the intervertebral discs.

Symptoms and signs of traumatic spinal cord injury

In addition to the anamnesis (primarily the mechanism of the accident), the clinical picture plays a decisive role for further diagnostic and therapeutic measures. The following are the main clinical aspects of traumatic spinal injuries:

• Pain in the area of ​​the fracture during tapping, compression, movement
• Stable fractures are usually painless; unstable fractures often cause more severe pain with limited movement
• Hematoma at the fracture site
• Spinal deformity (such as hyperkyphosis)
• Neurological prolapse: radicular pain and / or sensory disturbances, symptoms of incomplete or complete transverse spinal cord injury, dysfunction of the bladder and rectum in men, sometimes priapism.
• Respiratory failure with high cervical paralysis (C 3-5 innervate the diaphragm).
• Prolapse of the brainstem/cranial nerves in atlanto-occipital dislocations.
• Rarely traumatic injuries of the vertebral or basilar arteries.
• Spinal shock: transient loss of function at the level of spinal cord injury with loss of reflexes, loss of sensorimotor functions.
• Neurogenic shock: develops mainly with injuries of the cervical and thoracic spine in the form of a triad: hypotension, bradycardia and hypothermia.
• Autonomic dysreflexia in case of lesions within T6; as a result of the action of various nociceptive stimuli (for example, tactile irritation), an excessive sympathetic reaction with vasoconstriction and a rise in systolic pressure up to 300 mm Hg, as well as a decrease in peripheral circulation (pallor of the skin) may develop below the level of the focus. Above the level of the focus in the spinal cord, compensatory vasodilation develops (skin redness and sweating). In view of blood pressure crises and vasoconstriction - with the risk of cerebral hemorrhage, cerebral and myocardial infarction, arrhythmias up to cardiac arrest - autonomic dysreflexia is a serious complication.
• Brown-Séquard Syndrome: Usually a semi-spinal cord lesion with ipsilateral paralysis and loss of proprioception, as well as contralateral loss of pain and temperature sensations.
• Medullary cone syndrome: damage to the sacral spinal cord and nerve roots of the lumbar region with areflexia of the bladder, intestines and lower extremities with sometimes persistent reflexes at the sacral level (for example, bulbocavernosus reflex).
• Cauda equina syndrome: damage to the lumbosacral nerve roots with areflexia of the bladder, intestines and lower extremities.

Diagnosis of traumatic spinal cord injuries

The classification developed by the American Spinal Injury Association can be used to determine the level and severity of spinal cord injury.

Every patient with neurological deficits due to trauma needs adequate and timely primary diagnostic imaging. In patients with moderate to severe traumatic brain injury, it is necessary to examine the cervical spine, including the upper part of the thoracic region.

For mild to moderate injuries (without neurological deficits), the following signs indicate the need for timely imaging:

• Changing state of consciousness
• Intoxication
• Pain in the spine
• Distraction injury.

An important role in the decision to conduct imaging play elderly age patient and significant past or accompanying illnesses, as well as the accident mechanism.

Patients with a minor mechanism of injury and a low risk of damage often do not need hardware diagnostics, or only plain radiography (if indicated, additional functional radiography) is sufficient. As soon as the likelihood of spinal injury is identified based on risk factors and the course of injury, due to higher sensitivity, CT of the spine should be performed initially.

In case of possible vascular damage, CT angiography is additionally required.

MRI is inferior to CT in the emergency diagnosis of spinal injury, since it allows only a limited assessment of the extent of bone damage. However, in case of neurological deficits and ambiguous CT results, MRI should be additionally performed in case of emergency diagnosis.

MRI is shown mainly in the sub-acute phase and to monitor the dynamics of neural damage. In addition, the ligamentous and muscular components of the injury can be better assessed, as well as, if necessary, lesions in these components.

Visualization should answer the following questions:

• Is there any trauma at all?
• If yes, what type (fracture, dislocation, hemorrhage, brain compression, ligament lesions)?
• Is there an unstable situation?
• Is surgery required?
• Daffner recommends assessing spinal injury as follows:
• Alignment and anatomical abnormalities: anterior and posterior margin of the vertebral bodies in the sagittal plane, spinolaminar line, lateral masses, inter-articular and interspinous distance;
• Bone - violation of the integrity of the bone: rupture of the bone / fracture line, compression of the vertebral bodies, "bone nodules", displaced bone fragments;
• Cartilage-anomalies of the cartilage / joint cavity: an increase in the distances between the small vertebral joints (> 2 mm), inter-articular and interspinous distances, expansion of the intervertebral space;
• Soft tissue - soft tissue abnormalities: hemorrhages with extension to the retrotracheal (< 22 мм) и ретрофарингеальное пространство (>7 mm), paravertebral hematomas.

Severe spinal injuries should always look for other injuries (skull, chest, abdomen, blood vessels, limbs).

Laboratory diagnostics includes a hemogram, coagulogram, determination of the level of electrolytes and functional indicators of the kidneys.

For neurological disorders in subacute phase needs to be additional electrophysiological diagnostics to assess the extent of functional damage.

Complications of injuries of the spine and spinal cord

• Spinal instability with secondary spinal cord injuries
• Spinal cord injury (myelopathy) due to compression, contusion with various types of prolapse:
• - complete transverse paralysis (depending on the level of tetra- or paraplegia and corresponding sensory deficits)
• incomplete transverse paralysis (paraparesis, tetraparesis, sensory deficits)
• With a high cervical transverse lesion - respiratory failure
• Cardiovascular Complications:
• orthostatic hypotension (most pronounced in the initial phase, improvement over time)
• loss/weakening of diurnal fluctuations in blood pressure
• cardiac arrhythmias (in the case of lesions above T6, mainly bradycardia as a result of loss of sympathetic innervation and dominance of vagus nerve stimulation)
• Deep vein thrombosis and pulmonary embolism
• Long-term complications of transverse paralysis:
• areflexia (diagnosis = combination of arterial hypertension and vasoconstriction below the level of damage)
• post-traumatic syringomyelia: symptoms are often months or years later with neurological pain above the level of the focus, as well as an increase in neurological deficits and spasticity, deterioration in the functions of the bladder and rectum (diagnosis is established using MRI)
• heterotopic ossification = neurogenic paraarticular ossification below the level of the lesion
• spasticity
• painful contractures
• bedsores
• chronic pain
• urinary disorders with an increased percentage of urinary tract/kidney infections
• increased risk of infections (pneumonia, sepsis)
• intestinal motility and bowel movements
• psychological and psychiatric problems: stress disorder, depression

Treatment of traumatic spinal cord injuries

Depending on the scale of neurological damage and the immobility associated with them, great importance is attached to conservative, preventive and rehabilitation measures:

• Intensive medical monitoring, especially in the initial phase, to maintain normal cardiovascular and pulmonary functions;
• With arterial hypotension, an attempt at therapy by adequate fluid replacement; in the initial phase, according to indications, the appointment of vasopressors;
• Prevention of bedsores, thrombosis and pneumonia;
• Depending on the stability and course of the disease, early mobilization and physiotherapy measures.

Attention: autonomic disorders (orthostatic hypotension, autonomic dysreflexia) significantly complicate mobilization.

The indication for surgical intervention (decompression, stabilization) depends primarily on the type of injury. In addition to eliminating possible myelocompression, surgical intervention is necessary in unstable situations (injuries of types B and C).

Surgery requires the appropriate competence of neurosurgeons, trauma surgeons and orthopedists.

In severe traumatic compression of the spinal cord with neurological symptoms, urgent surgical decompression is indicated (within the first 8-12 hours). In the absence of neurological prolapse or in case of inoperability, depending on the type of injury, the possibility of conservative (non-invasive) treatment tactics is considered individually, for example, using a head HALO fixator for injuries of the cervical spine.

The use of methylprednisolone in spinal cord injury remains controversial. Despite scientific indications of an effect in case of early onset, critics note, first of all, side effects(eg, increased incidence of pneumonia and sepsis) and possible comorbidities (eg, traumatic brain injury, CRASH study). In case of spinal cord edema (or expected edema), methylprednisolone (eg Urbason) may be given. As a bolus, 30 mg/kg of body weight is administered intravenously followed by a long-term infusion. If the introduction is carried out within the first three hours after injury, a long-term infusion is carried out within 24 hours, if started between 3 and 8 hours after injury - within 48 hours.

The therapy of autonomic dysreflexia consists, first of all, in the elimination of the provoking stimulus. For example, a clogged urinary catheter that caused a distension of the bladder, inflammation of the skin, distension of the rectum. With persistent, despite the elimination of provoking stimuli, arterial hypertension, medications to reduce pressure, such as nifedipine, nitrates or captopril.

Prognosis for traumatic spinal cord injuries

The prognosis depends mainly on the location of the injury, its severity and type (polysegmental or monosegmental), as well as on the primary neurological status. In addition to the clinical picture, MRI is necessary to elucidate morphological lesions, and additional electrophysiological diagnostics (evoked sensory and motor potentials, EMG) are required to identify functional foci. Depending on the primary damage, total loss functions, partial loss of motor and sensory functions, but also their full restoration. The prognosis for severe intramedullary hemorrhage, edema, and spinal cord compression is poor.

Spinal cord injury is life threatening pathological condition in which the integrity of the spinal canal is partially or completely violated. The symptomatology of the violation can be different, it directly depends on the type of injury. Patients with injuries are hospitalized urgently.

When the spinal canal is damaged in humans, neurological disorders occur, 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 (especially often the spine is injured by the elderly);
• Gunshot and stab wounds;
• Some sports activities (motorcycling, diving and others).

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

Damage can be localized in different parts of the spine, but most often the thoracic or lumbar region suffers.

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

1. Closed - the skin over the damage is whole;
2. Open - soft tissues over the site of damage 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 dura mater is damaged).

With injuries of the spinal column, the ligamentous apparatus (rupture or tear of the ligament), vertebral bodies ( different types fractures, fissures, avulsion 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 of the nerve and bone structures of the spine are divided into:

• Flexion. A sharp bend causes a rupture of the posterior ligamentous apparatus and a dislocation occurs in the region of the 5-7th cervical vertebra;
• Hyperextension. It is characterized by rough extension, accompanied by a rupture of the already 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 protrusion forms;
• Vertical compression fracture. Due to movements along the vertical axis, the vertebrae are subject to dislocation or fracture;
• Fracture due to lateral bending.

Separately, injuries of a stable and unstable nature are distinguished. Explosive fractures, rotations, dislocations and fractures of various degrees are considered unstable. All these injuries are necessarily accompanied by a rupture of the 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 vertebral process fractures and wedge-shaped/compression fractures of their bodies.

Clinical forms of damage to the SM

The severity of spinal cord injury and its course in the 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 below the injury.

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

Bone fragments, foreign particles, and subcutaneous hemorrhages can maintain spinal shock. They are also able to stimulate the violation of hemo-and liquorodynamics. Accumulations of nerve cells located near the traumatic focus are in a strong inhibited state.

The clinical picture of damage depends on the type of spinal cord injury. Each injury is different in its characteristics, their symptoms are more similar to each other.

With a concussion, an irreversible process occurs in which the function of the spinal cord is impaired. Typical 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 trauma;

Motor disturbances are usually absent, but there may be a feeling of tingling and numbness in the legs. With a concussion of the spinal cord, the symptoms last a maximum of a week, after which they regress.

Injury

This is 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 the spinal tissue and infection through cracks, which can cause sepsis;
• Severe - nerve conduction is disturbed, due to which the medulla oblongata swells and thromboembolism and thrombosis 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 a rupture of the reflex arc.

Most often, compression occurs due to edema, hemorrhage, damage to the ligamentous apparatus and intervertebral discs, fragments of parts of the vertebrae or third-party bodies. Spinal cord compression can be:

1. Dorsal;
2. Ventral;
3. internal.

There are cases when compression is both dorsal and ventral at the same time. Usually this often happens with complex injuries. Compression of the spinal canal and roots is manifested by a 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 have symptoms of spinal shock, which manifests itself in the following way:

• Disappearance of somatic and autonomic reflexes;
• Paralysis of the 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, body parts below the point of injury are inactive, there is uncontrolled urination and defecation, thermoregulation and the process of sweating are disturbed.

Such an injury can be characterized as a single or multiple detachment of the roots, their compression or bruising, followed by hemorrhage. The clinical picture depends in part on which nerve roots have been damaged.

Common symptomatic manifestations of the lesion include:

1. Point pains;
2. Symptom of the reins (bilateral roller-shaped muscle spasm on the sides of the spinous process of the corresponding vertebra);
3. Swelling over the affected root;
4. Violation of sensitive perception (with the defeat of the roots of the cervical region, the arms and legs suffer, the thoracic or lumbar region - only the legs;
5. Dysfunctions of the pelvic organs;
6. Vegeto-trophic disorders.

If the roots in the cervical region (level 1-5 vertebrae) are damaged, the patient develops pain in the back of the head and neck, tetraparesis. Respiratory processes, swallowing and local blood circulation may also be disturbed. In addition, in patients with trauma to the cervical roots, stiffness in the movements of the neck is observed.

If the roots at the level of 5-8 cervical vertebrae are affected, various paralysis of the arms and legs occurs. With partial involvement of the roots of the thoracic region, Bernard-Horner syndrome is observed.

If the chest roots were damaged, abdominal reflexes disappear, activity is disturbed of cardio-vascular system and sensitivity, paralysis occurs. According to the hyposensitivity zone, it is possible to determine at what level the roots are affected.

Damage to the nerve roots at the level of the lower back and cauda equina is manifested by a violation of the innervation of the pelvic organs and lower extremities, 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 there is a rupture of blood vessels located near the central spinal canal or the posterior horns in the lumbar or cervical thickening.

Symptoms of hematomyelia are caused by compression of the gray matter and segments of the spine with 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 for a full recovery, but dysfunctions may occasionally return during life.

In very many clinical cases, trauma 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 completely lose their motor function and doctors cannot help in such a situation.

In addition, they have other background pathologies:

• Sexual impotence;
• Spasticity of muscles;
• bedsores;
• Tendinitis of the shoulder (it appears due to the constant manual control of a manual stroller);
• Dysreflexia of the autonomic nervous system;
• problems with the respiratory system;
• Violations 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 a motor function nevertheless, it was preserved, patients have to actively restore it and literally learn to walk again. However, spinal cord injuries almost never go unnoticed.

Due to a violation of the conduction of nerve impulses and a lack of muscle tone in patients, rare violations can occur on the part of different organ systems.

Patients who have suffered injuries of the spinal column and spinal cord in the past become more susceptible to other various injuries. Against the background of injuries in patients, sensitivity is disturbed and they can injure themselves without even noticing it.

Such patients should always perform potentially hazardous work with extreme caution and check themselves for injuries upon completion.

A patient who has received 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 research. Patients may be given:

Contrast venospondylography	The procedure is indicated for suspected spinal cord compression due to multi-level injuries of the spinal column. Venospondylography is not performed if the patient has pathologies of the liver, kidneys or iodine intolerance. When examining, a special contrast agent is injected into the vertebral veins through the spinous process or vertebral body (depending on the location of the injury), which normally the vessels should actively wash out. The procedure assesses the activity of the venous outflow during internal organs and external venous plexuses. Breakage of venous structures and congestive expansion of proximal vessels may indicate compression or rupture of individual areas circulatory system. The degree of circulatory disorders is directly related to the degree of spinal compression.
Electromyography	It is used to analyze the electrical conductivity of skeletal muscles and assess the functional state of the neuromuscular connection. There are several types of electromyography: stimulation; interference; local. Electromyography is considered the most informative technique for studying locomotor function in a person who has suffered a spinal cord injury.
The study of cerebrospinal fluid	The cerebrospinal fluid is involved in many body processes, so its composition can be used to analyze the effectiveness of therapy or make an approximate prognosis. In the analysis, experts pay attention to the cellular, chemical composition fluid and its biochemical parameters.
Lumbar puncture	It is used to extract cerebrospinal fluid, study cerebrospinal fluid pressure, analyze patency in the subarachnoid space of the spinal canal.
MRI and CT	Allows non-invasive examination of the state of the structures of the spinal cord. The study is indicated for injuries of varying severity.
spondinal endoscopy	It can be operating or puncture. Such a study allows you to examine the cavity of the spinal canal and its contents. With the help of spondinal endoscopy, damage (rupture, tortuosity, edema) of radicular structures, compression of the spinal cord can be detected.
Spondylography	X-ray examination, which is prescribed for almost everyone who has suffered a spinal cord injury. In combination with the result of a neurological examination and liquor test, the study allows us to assess the severity and extent of the injury.
Myelography	Research technique using contrast.
Discography	Another method of research using a contrast agent, with which you can study cracks in the vertebra, the presence of hernias, reproduce reflex-pain syndromes. In terms of technique, discography is somewhat similar to contrast venospondylography. The procedure involves the introduction of iodine contrast into the intervertebral disc using a thin needle. Fluid is injected until the disc begins to resist. The volume of its occupancy indicates the extent of the gap. Discography is performed in case of suspected rupture of the intervertebral discs, acute traumatic hernia and to determine the dependence of the reflex-pain syndrome on disc damage. If the patient is prescribed an MRI, then discography is usually not performed.

Treatment tactics

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

• Operational intervention. It is used in different periods of trauma treatment. After the operation, the patient goes through a long rehabilitation period. In some clinical cases, one patient may undergo several multi-purpose operations;
• Medical therapy. It is mainly used to combat neurological disorders, restore metabolism, increase reactivity, stimulate conductivity and increase capillary blood flow;
• Physiotherapeutic methods. They are used to accelerate regenerative and reparative processes, restore the activity of the musculoskeletal system and pelvic organs, increase the body's compensatory capabilities, prevent contractures and bedsores. For this, sessions of UHF, magnetotherapy, UVI, thermal procedures, electrophoresis and others are carried out;
• exercise therapy. It is carried out for the same purpose as physiotherapy. In some clinical cases, physiotherapy exercises are prohibited, therefore, 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 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 localization, the patient will experience a certain clinical picture.

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

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Spinal Injuries: Prevalence, Causes and Consequences

The prevalence of spinal injuries

According to various authors, spinal injuries account for 2 to 12% of cases of traumatic lesions of the musculoskeletal system.
The average portrait of the victim: a man under 45 years old. In old age spinal injury are observed with equal frequency in both men and women.

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

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

Injuries of the spinal column and spinal cord in children, including birth trauma of the spine, respond better to treatment and restorative rehabilitation thanks to the great adaptive capabilities of the child's body.

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

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

Anatomical structure of the spine and spinal cord

Anatomy of the spinal column

The spine consists of 31-34 vertebrae. Of these, 24 vertebrae are freely connected (seven cervical, twelve thoracic and five lumbar), and the rest are fused into two bones: the sacrum and the rudiment of the human tail - the coccyx.

Each vertebra consists of an anteriorly located body and an arc that limits the posterior vertebral foramen. 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 neighboring free vertebrae are connected in joints with strong capsules, so that the spinal column is an elastic movable joint.

The vertebral bodies are connected into a single whole with the help of elastic fibrous discs. Each disc consists of an annulus fibrosus, within which is the nucleus pulposus. This design:
1) provides mobility of the spine;
2) absorb shock and load;
3) stabilizes the spinal column as a whole.

The intervertebral disc is devoid of blood vessels, nutrients and oxygen is supplied by diffusion from adjacent vertebrae. Therefore, all recovery processes take place here too slowly, so that with age a degenerative disease develops - osteochondrosis.

Additionally, the vertebrae are connected by ligaments: longitudinal - anterior and posterior, interarticular or "yellow", interspinous and supraspinous.

The first (atlas) and second (axial) cervical vertebrae are not like the rest. They have changed as a result of human upright walking and provide a connection between the head and the spinal column.

Atlas has no 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-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 the 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.

Spinal Cord Anatomy

Located inside the spinal column, the spinal cord is covered with three shells, which are a continuation of the shells of the brain: hard, arachnoid and soft. From top to bottom, it narrows, forming a brain cone, which at the level of the second lumbar vertebra passes into the terminal thread, surrounded by the roots of the lower spinal nerves (this bundle is called the cauda equina).

Normally, there is a reserve space between the spinal canal and its contents, which makes it possible to painlessly endure the 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 for the innervation of 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 into the depths of 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 radicular arteries, which are variable and absent in some segments; at the same time, sometimes one radicular artery feeds several segments at once.

With deforming injury blood vessels are bent, squeezed, overstretched, their inner lining is often damaged, as a result of which thrombosis is formed, which leads to secondary circulatory disorders.

It has been clinically proven that lesions of the spinal cord are often associated not with a direct traumatic factor (mechanical trauma, compression by fragments of the vertebrae, etc.), but with impaired blood supply. Moreover, in some cases, due to the peculiarities of blood circulation, secondary lesions can capture fairly large areas outside the action of the traumatic factor.

Therefore, in the treatment of spinal injuries complicated by lesions of the spinal cord, the fastest elimination of deformity and restoration of normal blood supply are shown.

Classification of spinal injuries

Spinal injuries are divided into closed (without damage to the skin and tissues covering the vertebra) and open (gunshot wounds, stab wounds, etc.).
Topographically distinguish injuries of different parts of the spine: cervical, thoracic and lumbar.

According to the nature of the damage, there are:

• bruises;
• distortions (tears or ruptures of ligaments and bags of joints of the vertebrae without displacement);
• fractures of the spinous processes;
• fractures of the transverse processes;
• fractures of the vertebral arches;
• fractures of the vertebral bodies;
• subluxations and dislocations of the vertebrae;
• fracture-dislocation of the vertebrae;
• traumatic spondylolisthesis (gradual displacement of a vertebra anteriorly due to destruction of the ligamentous apparatus).

In addition, the distinction between stable and unstable injuries is of great clinical importance.
Unstable spinal injury is a condition in which the resulting deformity as a result of an injury can worsen in the future.

Unstable injuries occur with combined damage to the posterior and anterior sections 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.

It is clinically important to divide 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 disorders (concussion).
2. Irreversible damage (bruise or contusion).
3. Spinal cord compression syndrome (may be caused by fragments and fragments of parts of the vertebrae, fragments of ligaments, nucleus pulposus, hematoma, edema and swelling of tissues, as well as several of these factors).

Symptoms of spinal injuries

Symptoms of a Stable Spinal Injury

Stable injuries of the spine include bruises, distortions (rupture of ligaments without displacement), fractures of the spinous and transverse processes, and whiplash injuries.

When the spine is bruised, the victims complain of diffuse soreness at the site of injury. During the examination, swelling and hemorrhage are detected, movements are slightly limited.
Distortions occur, as a rule, with a sharp lifting of weights. They are characterized sharp pain, a sharp limitation of movements, pain when pressing on the spinous and transverse processes. Sometimes the phenomena of sciatica join.

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 a strong muscle contraction. The main signs of fractures of the spinous processes: sharp pain on palpation, sometimes you can feel the mobility of the damaged process.

Fractures of the transverse processes are caused by the same causes, but are more common.
They are characterized by the following symptoms:
Payr's sign: localized pain in the paravertebral region, aggravated by turning in the opposite direction.

Stuck heel symptom: when positioned on the back, the patient cannot tear the straightened leg from the bed on the side of the lesion.

In addition, there is diffuse soreness at the site of injury, sometimes accompanied by symptoms of sciatica.

Whiplash injuries of the neck, which are typical for intra-vehicle accidents, are usually referred to as stable injuries of the spine. However, quite often they have severe neurological symptoms. Spinal cord injuries are caused by both direct contusion upon injury and circulatory disorders.

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

Signs of injuries of the middle and lower cervical spine

Injuries of the middle and lower cervical vertebrae occur in road accidents (60%), jumping into water (12%) and falls from a height (28%). At present, injuries of these departments account for up to 30% of all spinal injuries, one third of them occur with lesions of the spinal cord.

Dislocations, subluxations and fracture-dislocations are quite common due to the special mobility of the lower cervical spine, and are classified into overturning and sliding. The former are characterized by pronounced kyphosis (posterior bulge) and expansion of the interspinous space due to rupture of the supraspinous, interspinous, interspinous, and posterior longitudinal ligaments. With sliding injuries, a bayonet-like deformation of the spine, fractures of the articular processes are observed. The victims are worried about severe pain and forced position of the neck (the patient supports his head with his hands). Often there are spinal cord injuries, the severity of which largely determines the prognosis.

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

Symptoms of injuries of the thoracic and lumbar spine

For injuries of the thoracic and lumbar spine, fractures and fracture-dislocations are characteristic; isolated dislocations occur only in the lumbar region, and then extremely rarely, due to limited mobility.

There are many classifications of injuries of the thoracic and lumbar spine, but they are all complex and cumbersome. The most simple 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, there are:

• 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 are subject to conservative treatment);
• wedge-comminuted (the entire thickness of the vertebral body and the upper closing plastic are damaged, so that the process affects the intervertebral disc; the injury is unstable, and in some cases requires surgical intervention; it can be complicated by damage to the spinal cord);
• fracture-dislocations (destruction of the vertebral body, multiple injuries of 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).

Compression fractures that occur as a result of a load along the axis of the spine should be singled out separately (compression fractures occur in the lower thoracic and lumbar regions when falling on the legs, and in the upper thoracic region when falling on the head). With such fractures, a vertical crack forms in the vertebral body. The severity of the lesion and the tactics of treatment will depend on the degree of divergence of the fragments.

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 muscles of the back (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 injury

Movement disorders

Movement disorders in spinal cord injuries, as a rule, are symmetrical. The exceptions are stab wounds and damage to the cauda equina.

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.

Movement disorders depend on the level of the lesion. The critical level is the fourth cervical vertebra. Paralysis of the diaphragm, which develops with lesions of the upper and middle cervical regions of the spinal cord, leads to respiratory arrest and death of the patient. Spinal cord injury in the lower cervical and thoracic segments leads to paralysis of the intercostal muscles and respiratory failure.

Sensitivity disorders

Damage to the spinal cord is characterized by violations of all types of sensitivity. These disorders are both quantitative (decrease in sensitivity up to complete anesthesia) and qualitative in nature (numbness, crawling sensation, etc.).

The severity, nature and topography of sensitivity disorders is important diagnostic value, as it indicates the location and severity of the spinal cord injury.

It is necessary to pay attention to the dynamics of violations. A gradual increase in signs of impaired sensitivity and movement disorders is typical for compression of the spinal cord by bone fragments, fragments of ligaments, a hematoma, a shifting vertebra, and also for circulatory disorders due to compression of blood vessels. Such conditions are an indication for surgical intervention.

Visceral-vegetative disorders

Regardless of the localization of damage, visceral-vegetative disorders are manifested primarily in disorders of the pelvic organs (stool retention and urination). In addition, with high damage, there is a mismatch in the activity of the organs of the digestive tract: an increase in the secretion of gastric juice and pancreatic enzymes while reducing the secretion of intestinal juice enzymes.

The speed of blood flow in the tissues is sharply reduced, especially in areas with reduced sensitivity, microlymph outflow is disturbed, and the phagocytic ability of blood neutrophils is reduced. All this contributes to the rapid formation of hard-to-treat bedsores.

Complete rupture of the spinal cord is often manifested by the formation of extensive bedsores, ulceration gastrointestinal tract with massive bleeding.

Treatment of injuries of the spine and spinal cord

The basic principles of treatment of injuries of the spine and spinal cord: the timeliness and adequacy of first aid, compliance with all rules when transporting victims to a specialized department, long-term treatment with the participation of several specialists and subsequent repeated courses of rehabilitation.

When providing first aid, much depends on the timely diagnosis of the injury. It should always be remembered that in the case of car accidents, falls from a height, building collapses, etc., the possibility of damage to the spinal column must be taken into account.

When transporting victims with a spinal injury, all precautions must be taken so as not to aggravate the injury. Such patients should not be transported in a sitting position. The victim is laid on a shield. At the same time, an air mattress is used to prevent bedsores. In case of damage to the cervical spine, the head is additionally immobilized with the help of special devices (tires, 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 the 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.

With relatively mild stable injuries of the spine (distortions, whiplash injuries, etc.), bed rest, massage, and thermal procedures are indicated.

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

open surgical removal deformation relieves compression of the spinal cord and helps restore normal blood circulation in the affected area. Therefore, the growing symptoms of spinal cord injury, indicating its compression, are always an indication for urgent surgical intervention.

To 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, if indicated, traction.

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

Rehabilitation after injuries of the spine and spinal cord

Recovering from a spinal injury is a lengthy process.
For spinal injuries not complicated by spinal cord injury, exercise therapy is indicated from the first days of injury: at first it consists of breathing exercises, from the second week limb movements are allowed. Exercises gradually complicate, focusing on general state sick. In addition to exercise therapy for uncomplicated spinal injuries, massage and thermal procedures are successfully used.

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

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

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

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

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