Spinal cord injury and its consequences. Injury (rupture) of the human spinal cord - what are the consequences? Partial rupture of the spinal cord

The spinal cord is located in the spinal canal and is responsible for the functioning of the digestive, respiratory, reproductive, urinary and other important systems of the body. Any violations and injuries of the spine and nervous tissue are fraught with disturbances in the functioning of organs and other pathological phenomena.

Doctors consider spinal cord injuries to be stretching, squeezing, bruising with intracerebral hemorrhage, ruptures or detachments of one or more nerve roots, as well as infectious lesions and developmental anomalies. In the article, we will look at the symptoms, diagnosis and treatment of injuries of the spine and spinal cord. You will learn how pre-hospital care and transportation of a victim with spinal cord injuries is performed.

Disorders in the spinal cord cause both independent diseases and injuries of the spine. The causes of spinal cord injuries are divided into 2 large groups: traumatic and non-traumatic.

Traumatic causes include:

Non-traumatic causes of spinal cord injury:

• inflammatory processes: myelitis (viral or autoimmune);
• tumors: sarcoma, lipoma, lymphoma, glioma;
• radiation myelopathy;
• vascular spinal syndromes, vascular compression;
• myelopathy associated with metabolic disorders;
• purulent or bacterial infection: tuberculous, mycotic spondylitis;
• chronic rheumatic pathologies of the spine: rheumatoid, reactive arthritis, disease;
• degenerative changes in the spine: osteoporosis, spinal canal stenosis,.

Types of injury

Spinal cord injuries are classified on various grounds. There are open injuries with damage to soft tissues and skin and closed injuries without external damage.

Types of spinal injuries:

• sprains or ruptures of the ligaments of the spine;
• vertebral fractures: compression, comminuted, marginal, explosive, vertical and horizontal;
• intervertebral disc injuries;
• dislocations, subluxations, fracture-dislocations;
• spondylolisthesis or displacement of the vertebrae.

Types of spinal cord injuries:

• injury;
• squeezing;
• partial or complete break.

Bruises and compression are usually associated with spinal injury: dislocation or fracture. With a bruise, the integrity of the spinal tissue is violated, hemorrhage and swelling of the brain tissue are observed, the scale of which will depend on the degree of damage.

Compression occurs with fractures of the vertebral bodies. It can be partial or complete. Squeezing is not uncommon in divers; most often damaged lower cervical vertebrae.

The victim develops atrophic paralysis of the arms, paralysis of the legs, decreased sensitivity in the area below the level of the lesion, problems with the pelvic organs and bedsores appear in the area of ​​the sacrum.

Compression in the area of ​​the lumbosacral spine leads to paralysis of the legs, loss of sensation and dysfunction of the pelvic organs.

Symptoms

Signs of spinal cord injury depend on the type of injury and where it occurred.

Common signs of spinal cord problems:

Spinal cord injury in newborns most often occurs in the cervical or lumbar regions. The fact is that the spinal cord in a baby, in comparison with the spine and ligaments, is less extensible and is easily damaged during injuries without visible changes in the spine itself.

In some situations, even a complete rupture of the spinal cord occurs, although no changes will be visible on the x-ray.

Due to neck injury during childbirth, the baby will be in a state of anxiety. The neck can be bent, lengthened or shortened. An infant has the same symptoms as an adult: spinal shock, edema, breathing problems, disturbances in the functioning of internal organs, muscle atrophy, reflex and movement disorders.

First aid

The consequences of injuries will be less dangerous if first aid is provided correctly. The victim is laid flat on a hard surface and transported on a rigid shield. If immobilization is not carried out, bone fragments and fragments will continue to compress the spinal cord, which is fraught with death.

The injured person is carried exclusively on a hard surface. If damage to the cervical region is suspected, the head is additionally fixed with a tire from improvised means (cloth rollers are suitable).

Attention! Do not sit down or try to lift the victim to his feet. It is required to monitor breathing and pulse and, if necessary, to carry out resuscitation.

Main rules:

1. Restrict the victim's movements, place him on a hard surface and fix the injured area with improvised means.
2. Give pain medication if needed.
3. Make sure the victim is conscious.

In a situation of severe injury, the spinal cord is switched off for some time, a state of shock occurs. Spinal shock is accompanied by impaired sensory, motor and reflex functions of the spinal cord.

The disturbance extends below the damage level. During this period, it is impossible to determine a single reflex, only the heart and lungs work. They function offline, other organs and muscles also do not work.

While waiting for the shock to pass and the spinal cord to start working, the muscles are supported with electrical impulses to prevent atrophy.

Diagnostics

How to check the spinal cord in a person after an injury? To determine the level of damage, an x-ray is taken (at least in 2 planes).

Computed and magnetic resonance imaging provide the most detailed picture of the state of the spine and spinal cord. Here you can see the spinal cord in both longitudinal and transverse sections, identify hernias, splinters, hemorrhages, damage to the nerve roots and tumors.

Myelography carried out for the purpose of diagnosing nerve endings.

Vertebral angiography shows the state of the blood vessels of the spine.

Lumbar puncture is done to analyze the cerebrospinal fluid, to detect infection, blood, or foreign bodies in the spinal canal.

Treatment Methods

Treatment for the spinal cord depends on the severity of the injury. In case of mild injury, the victim is prescribed bed rest, taking painkillers, anti-inflammatory and restorative drugs.

In case of violation of the integrity of the spine, compression of the spinal canal and the presence of severe injuries, surgery is necessary. It is produced to restore damaged tissues of the spine and spinal cord.

Serious injuries require emergency surgery. If you do not help the victim in time, 6-8 hours after the injury, irreversible consequences may occur.

In the postoperative period, a course of intensive therapy is carried out to prevent side effects. In this process, the work of the cardiac system, respiration is restored, cerebral edema is eliminated and infectious lesions are prevented.

Orthopedic

Orthopedic treatment includes reduction of dislocations, fractures, traction and prolonged immobilization of the spine. The patient is recommended to wear a cervical collar for injuries of the cervical spine or an orthopedic corset for the treatment of the thoracic or lumbar regions.

Conservative treatment involves the use of the spinal traction method. If the thoracic and lumbar spine is damaged, traction is carried out using loops, hanging the patient by the armpits.

Also used are beds with a raised headboard. In the treatment of cervical traction, a Glisson loop is used. This device is in the form of a loop, where the head with a cable and a counterweight is attached. Due to the counterweight, a gradual stretching occurs.

Medical therapy includes taking anti-inflammatory and analgesic drugs. Preparations are prescribed to restore blood circulation, strengthen the body and activate the processes of tissue regeneration.

If the victim develops spinal shock, dopamine, atropine, and large doses of methylprednisolone are used. With pathological muscle stiffness, centrally acting muscle relaxants are prescribed (). To prevent the development of inflammatory phenomena, broad-spectrum antibiotics are taken.

Rehabilitation

The rehabilitation period takes up to several months. After the restoration of the integrity of the spinal cord, training begins to restore physical activity.

Therapeutic training of the first week begins with breathing exercises. In the second week, they include movements with arms and legs. Gradually, depending on the condition of the patient, the exercises complicate, transfer the body to a vertical position from a horizontal one, increase the range of motion and load.

As you recover, massage is included in the rehabilitation process.

Physiotherapy is carried out to restore motor activity, prevent bedsores and disorders of the pelvic organs. It promotes tissue regeneration in the area of ​​injury and lymphatic drainage, improves blood circulation, cell and tissue metabolism, reduces swelling and inflammation.

For treatment, ultrasound, magnetotherapy, general ultraviolet irradiation, electrophoresis with lidase and novocaine, phonophoresis are used.

Reference. Physiotherapy in combination with drugs improves nutrition and absorption of active substances in tissues and cells.

For paralysis and paresis of the lower extremities, hydro-galvanic baths, massage with a shower under water, mud applications are used. Mud therapy can be replaced with ozocerite or paraffin.

For pain syndrome, balneotherapy, radon and coniferous baths, as well as vibration and whirlpool baths are used.

Along with physical therapy, hydrokinesiotherapy and swimming in the pool are used.

Complications of spinal cord injury

Complications come:

• in case of untimely medical assistance;
• in case of violations by patients of the discipline of treatment and rehabilitation;
• in case of neglect of the doctor's recommendations;
• as a result of the development of infectious and inflammatory side processes.

There are no serious consequences from a slight bruise, local hemorrhage in the tissues of the spinal cord, compression or concussion, the victim recovers completely.

In severe cases - with extensive bleeding, fractures of the spine, severe bruises and pressure - bedsores, cystitis, pyelonephritis appear.

If the pathology takes a chronic form, paresis, paralysis develop. In the event of an unfavorable outcome, a person completely loses motor functions. These patients require constant care.

Conclusion

Any damage to the spinal cord is fraught with serious problems. Untimely treatment, disregard for the condition of your spine and medical recommendations can lead to disastrous results.

The rapid rhythm of life makes us rush somewhere, rush, run without looking back. But it is worth an unsuccessful fall - and a sharp pain pierces the back. A disappointing diagnosis from the lips of a doctor interrupts the endless rush. Spinal cord injury - frightening words, but are they a sentence?

What is spinal cord injury

The spinal cord of a person is reliably protected. It is closed by a strong bone frame of the spine, while it is abundantly supplied with nutrients through the vascular network. Under the influence of various factors - external or internal - the activity of this stable system can be disrupted. All changes that develop after damage to the cerebrospinal substance, surrounding membranes, nerves and blood vessels are collectively known as "spinal cord injury".

A spinal cord injury may be called a spinal cord injury or, in a latinized manner, a spinal cord injury. There are also the terms "spinal cord injury" and "traumatic disease of the spinal cord". If the first concept denotes, first of all, the changes that occurred at the time of damage, then the second describes the whole complex of developed pathologies, including secondary ones.

Such a pathology can affect any of the sections of the spine in which the spinal canal passes with the spinal cord:

• cervical;
• chest;
• lumbar.

The spinal cord is at risk of injury at any point

Classification of spinal injuries

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

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

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

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

The choice of treatment depends on the nature of the injury.

The nosological classification is based on a detailed description of the affected tissues, types of lesions and characteristic symptoms. In her system, the following types of damage are indicated:

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

Causes and development factors

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

• traumatic - a variety of mechanical effects that provoke tissue destruction:
  • fractures;
  • dislocations;
  • hemorrhages;
  • bruises;
  • squeezing;
  • concussions;
• pathological - changes in tissues caused by disease states:
  • tumors;
  • infectious diseases;
  • circulatory disorders;
• congenital - anomalies of intrauterine development and hereditary pathologies.

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

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

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

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

• self-destruction (apoptosis) of damaged tissues;
• oxygen starvation;
• nutrient deficiency;
• accumulation of toxic decay products.

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

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

In the initial periods, the symptoms are shifted towards neurological symptoms (paralysis, loss of sensitivity), at the last stages - towards organic changes (dystrophy, tissue necrosis). Exceptions are concussions, which are characterized by a rapid course, and sluggish chronic diseases. Causes, location and severity of injury have a direct impact on the set of likely symptoms..

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

Table: symptoms of spinal cord injuries

Diagnosis of spinal cord injuries

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

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

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

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

Palpation reveals displacement of bones, swelling of tissues, unnatural muscle tension, and various deformations. Neurological examination reveals changes in reflexes.

Accurate diagnosis requires the use of instrumental techniques. These include:

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

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

The applied diagnostic techniques allow to differentiate different types of spinal cord injuries among themselves, depending on their severity and causes. The result obtained directly affects the tactics of further therapy.

Treatment

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

First aid

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

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

The method of immobilization depends on the point of injury. A person with injuries in the cervical region is placed on a stretcher face up, after fixing his neck with:

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

Injuries to the thoracic or lumbar regions force the victim to be transported on a shield or hard stretcher. In this case, the body should be in a prone position on the stomach, a dense roller is placed under the head and shoulders.

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

With the development of spinal shock, it may be necessary to normalize cardiac activity with atropine or dopamine. A strong pain syndrome involves the introduction of analgesics (Ketanov, Promedol, Fentanyl). Salt solutions and their derivatives (Hemodez, Reopoliglyukin) are used for heavy bleeding. Broad-spectrum antibiotics (Ampicillin, Streptomycin, Ceftriaxone) are needed to prevent infection.

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

• cleaning the oral cavity from foreign bodies;
• artificial ventilation of the lungs;
• indirect heart massage.

After providing emergency care, the patient should be immediately taken to the nearest neurosurgical facility. It is strictly prohibited:

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

Inpatient treatment for bruises, concussions and other types of injuries

A set of therapeutic measures depends on the nature and severity of the injury. Light injuries - bruises and concussions - provide only drug therapy. Other types of injuries are treated in combination. In some situations that threaten irreversible changes in the tissues of the spinal cord, an emergency surgical intervention is required - no later than 8 hours after the moment of injury. Such cases include:

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

It should be borne in mind that extensive internal injuries can endanger the patient's life during the operation. Therefore, in the presence of the following pathologies, immediate surgical intervention is contraindicated:

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

Medical therapy

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

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

Photo gallery of medicines

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

Decompression when squeezing the spinal cord

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

Traction fixation reduces pressure on the spine

Surgical decompression is performed by direct access to the spine:

• anterior (pretracheal) - in case of cervical injury;
• anterolateral (retroperitoneal) - in case of damage to the lumbar vertebrae;
• side;
• back.

Vertebrae may be subject to:

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

At the same time, normal innervation and blood supply to the affected area is restored. Upon completion of this, the spine is stabilized with a bone autograft or a metal implant. The wound is closed, the damaged area is immovably fixed.

Metal implants stabilize the spine after surgery

Video: spinal fracture surgery

Rehabilitation

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

• increased blood microcirculation in damaged areas;
• facilitating the delivery of medicines to the centers of regeneration;
• stimulation of cell division;
• preventing muscle dystrophy;
• improvement of the psycho-emotional state of the patient.

Proper nutrition

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

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

Exercise therapy and massage

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

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

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

An example set is as follows:

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

Other physiotherapy techniques for recovery from injury

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

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

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

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

Video: Dr. Bubnovsky about rehabilitation after spinal cord injuries

Treatment prognosis and possible complications

The prognosis of treatment depends entirely on the extent of the damage. Light injuries do not affect a large number of cells. Lost nerve circuits are quickly compensated for by free connections, so that their restoration occurs quickly and without consequences. Extensive organic damage is dangerous for the life of the victim from the first moment of its existence, and the prognosis for their treatment is ambiguous or even disappointing.

The risk of complications greatly increases without providing the necessary medical care in the shortest possible time.

Extensive damage to the spinal cord threatens with many consequences:

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

Prevention

There are no specific measures to prevent spinal cord injury. You can simply limit yourself to caring for your body, maintaining it in proper physical shape, avoiding excessive physical exertion, shocks, shocks, and collisions. Scheduled examinations by a specialist therapist will help to identify hidden pathologies that threaten the health of the back.

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. The most undesirable damage to the cervical spine. Treatment should begin as early as possible with emergency care, inpatient care, and recovery.

Spinal cord injury occurs for the following reasons:

• in road traffic accidents, various injuries occur (bruises, fractures, dislocations, contusion of different parts of the 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. Common symptoms: loss of consciousness, malfunction of organs (heart, lungs), paralysis, impaired thermoregulation of the body, the onset of a state of shock, 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 signs increase, surgical intervention is necessary (with compression of 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 a fracture or dislocation of the two upper vertebrae occurs, 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 an acute stage of 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. Can detect the presence of blood, infection, foreign bodies in the spinal canal.
• When making a diagnosis, the cause of the injury, the severity of clinical symptoms, the effectiveness of first aid, the results of the examination and research methods are taken into account.

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. In a 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. They optimize disorders of the cardiovascular and respiratory systems, eliminate cerebral edema, and prevent infections.

Medical treatment involves the appointment of drugs. 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, for chronic pain - painkillers, muscle relaxants, medicines to improve the functioning of the intestines, bladder, and genital organs.

Spinal cord - it is the nerve tissue that runs down from the brain in the spinal canal of the back. The spinal canal is surrounded by the spine in the form of a bone structure that protects the spinal cord from various injuries.

Thirty-one spinal nerves branch from the spinal cord to the chest, abdomen, legs, and arms. These nerves instruct the brain to move certain parts of the body. In the upper part of the spinal cord there are nerves that control the arms, heart, lungs, in the lower part - the legs, intestines, bladder, etc. Other nerves return information from the body to the brain - the sensation of pain, temperature, body position, and so on.

Causes of spinal cord injury

• road traffic injuries
• falling from height
• sports injuries
• brain tumor
• infectious and inflammatory processes
• vascular aneurysm
• prolonged lowering of blood pressure

The spinal cord, unlike other parts of the body, is incapable of recovery, so damage to it leads to irreversible processes. Spinal cord injury can be the result of more than one process: spinal injuries, circulatory disorders, infections, tumors, etc.

Spinal cord injury

Severe symptoms Spinal cord injury manifests itself depending on two factors: the location of the injury and the extent of the injury.

The location of the damage.

The spinal cord can be damaged either at the top or at the bottom. Depending on this, the symptoms of damage are also distinguished. If the upper part of the spinal cord is damaged, then such damage causes more paralysis. For example, fractures of the upper spine, especially the first and second cervical vertebrae, lead to - both arms and both legs. In this case, the patient is able to breathe only with the help of an artificial respiration apparatus. If the lesions are located lower - in the lower parts of the spine, then only the legs and lower body can be paralyzed.

Degree of damage.

Distinguish the severity of spinal cord injuries. Damage can be either partial or complete. This again depends on the location of the injury - that is, which part of the spinal cord in this case was damaged.

Partial spinal cord injury. With this type of injury, the spinal cord transmits only some signals to and from the brain. In this regard, patients remain sensitive, but only to some extent. Separate motor functions are also preserved below the affected area.

Complete damage to the spinal cord. With complete, there is a complete or almost complete loss of motor function, as well as sensitivity below the affected area. But I must say that the spinal cord, even with complete damage, will not be cut. But only the spinal cord, which has undergone partial damage, can be restored, while a completely damaged brain is not restored.

Symptoms of spinal cord injury

• intense burning and pain
• inability to move
• partial or complete loss of sensation (heat, cold, tactile sensations)
• inability to control the functioning of the bladder and bowels
• mild cough, shortness of breath
• changes in sexual and reproductive functions

Critical symptoms

• occasional loss of consciousness
• loss of coordination
• numbness in the fingers and toes, in the hands and feet
• paralysis of body parts
• curvature of the neck and back