Spinal cord injury in the lumbar region. Injury (rupture) of the human spinal cord - what are the consequences? Ergotherapy as a successful method of complex rehabilitation

23.06.2020 -

A spinal cord injury is a lesion resulting from injury or disease to any part of the spinal cord or nerves of the spinal canal. These injuries often cause impairment or loss of motor or sensory function.

Many scientists do not give up the idea that spinal cord injury will someday be completely reversible. Therefore, research in this area is being conducted around the world. At the same time, the treatment and rehabilitation programs that exist today allow many patients to become an active member of society again.

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

The severity of the injury is divided into:

Full damage

Such an injury leads to a loss of sensation and motor functions of all organs and parts of the body that are below the level of damage.

Incomplete Damage

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

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

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

The attending physician will perform a series of tests to determine the neurological level of the lesion and the severity of the injury.
Signs and symptoms of spinal cord injury (may appear as several or one of the following):
loss of motor functions
loss of sensation, including the ability to feel heat, cold, or touch.
loss of bowel and bladder control
increased muscle tone or uncontrollable spasms
sexual dysfunction and infertility
pain or tingling caused by damage to nerve fibers in the spinal cord
shortness of breath, cough.

Early signs of a spinal cord injury:

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

When to see a doctor

Anyone who has sustained a serious head or neck injury should seek immediate medical attention. Doctors will evaluate and possible damage to the spinal cord. For any suspected spinal cord injury, doctors should perform all proper medical procedures until proven otherwise, this is important because:

A serious spinal injury is not always immediately obvious. If it is not recognized in time, it can lead to more serious consequences.
Numbness or paralysis may also take some time to appear, and if left undiagnosed, prolonged internal bleeding and swelling in or around the spinal cord can worsen the situation.
The time elapsed after the injury and the provision of medical care directly affects the possible complications and subsequent rehabilitation of the patient.

How to deal with someone who has just been injured:

Call 1719 or the nearest hospital emergency room.
Put towels on both sides of the head and neck to keep them still and wait for an ambulance.
Administer first aid to the casualty: take steps to stop bleeding and keep the casualty as comfortable as possible without moving the neck or head.

Damage to the spinal cord is possible as a result of damage to the vertebrae, ligaments or discs of the spine. Traumatic spinal cord injury may be associated with a sudden blow to the spine, resulting in a fracture, displacement, or compression of the vertebrae. Spinal cord injury can also be obtained as a result of a gunshot or knife wound. Complications usually occur within days or weeks of injury due to bleeding, swelling, inflammation, and fluid buildup in and around the spinal cord.

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

Your brain and central nervous system

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

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

Damage to nerve fibers

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

Common causes of spinal cord injury

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

Road traffic accidents. Crashes involving cars and motorcycles are the leading cause of spinal cord injury, over 40% annually.

Falls. Spinal cord injuries in the elderly (after 65 years) are usually associated with a fall. In general, statistics allocate ¼ of all cases to this reason.

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

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

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

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

Although such injuries are usually accidental, a number of factors have been identified that predispose to risk, such as:

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

Age. As a rule, injuries are received at the most active age - from 16 to 30 years. Road accidents remain the leading cause of injury at this age.

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

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

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

Specialists of the Rehabilitation Center will offer a number of methods for controlling vital processes (the work of the bladder and intestines). A special diet will be developed to improve organ functions, which will help to avoid future kidney stones, urinary tract and kidney infections, obesity, diabetes, etc. Under the supervision of experienced physiotherapists, a program of physical exercises will be developed to improve the patient's muscle tone. You will receive detailed advice on skin care to avoid pressure sores, maintaining the functioning of the cardiovascular and respiratory systems. Specialists in the field of urology and infertility treatment can also be involved if necessary. Doctors will teach you how to deal with pain and depression. We are able to offer an integrated approach for the complete stabilization of the patient's condition.

Medical research:

Radiography. This is where the study should start. The pictures give a general picture of the situation, allow assessing the deformation of the spine, detecting fractures, dislocations of the bodies and processes of the vertebrae, and clarifying the level of damage.

Computed tomography (CT). CT scan gives more detailed information about the damaged area. When scanning, the doctor receives a series of cross-sectional images and provides a detailed study of the walls of the spinal canal, its membranes and nerve roots.

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

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

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

Providing emergency medical care

Providing prompt first aid is critical to minimizing the effects of any head or neck injury. Similarly, spinal cord injury treatment often begins at the scene.

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

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

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

Immobilization. Stabilization of the injured spine during transportation is extremely important. To do this, the brigade has in its arsenal special devices for keeping the spine and neck stationary.

Surgical intervention. Often, doctors are forced to resort to operations to remove fragments of bones, foreign objects, herniated discs, or fix a fractured vertebrae. Surgery may also be needed to stabilize the spine to prevent pain or bone deformity in the future.

Hospitalization period

After the patient is stabilized and the priority treatment is carried out, the staff begins to work to prevent complications and related problems. This may be a deterioration in the patient's physical condition, muscle contracture, bedsores, disruption of the intestines and bladder, respiratory infections and blood clots.

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

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

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

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

New technologies. To date, modern means of transportation have been invented for people with disabilities, providing full mobility of patients. For example, modern lightweight wheelchairs on an electric drive. Some of the latest models allow the patient to independently climb the stairs and lift the seated person to any desired height.

Forecasts and Recovery

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

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

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

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

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

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, are more amenable to treatment and rehabilitation due to the greater adaptive capacity 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 are supplied by diffusion from neighboring 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 a deforming injury, the blood vessels are bent, compressed, overstretched, their inner lining is often damaged, resulting in thrombosis, 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 by acute 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).

Separately, compression fractures that occur as a result of a load along the axis of the spine should be singled out (when falling on the legs, compression fractures occur in the lower thoracic and lumbar regions, and when falling on the head, in the upper thoracic region). 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. 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. Damage to the spinal cord 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 sensory disturbances are of great diagnostic value, since they indicate the location and severity of spinal cord injury.

It is necessary to pay attention to the dynamics of violations. A gradual increase in signs of sensory disturbance and movement disorders is characteristic of compression of the spinal cord by bone fragments, fragments of ligaments, hematoma, a shifting vertebra, as well as circulatory disorders due to vascular compression. 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 of the gastrointestinal tract with massive bleeding.

Treatment of injuries of the spine and spinal cord

The main principles of treatment of spinal cord and spinal cord injuries are: 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 of the deformity 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.

Surgical methods are also resorted to 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 the injury: at first it consists of breathing exercises, from the second week limb movements are allowed. Exercises gradually complicate, focusing on the general condition of the patient. In addition to exercise therapy for uncomplicated spinal injuries, massage and thermal procedures are successfully used.

Rehabilitation for spinal cord injuries is supplemented by electrical impulse 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 (vitreous body, etc.) are also prescribed to improve metabolism and speed up recovery after injury.

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

The 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 is of great social importance, since, according to statistics, spinal injuries lead to disability for the most active part of the population.

There are contraindications. Before use, you should consult with a specialist.

Spinal cord injury is one of the most severe injuries encountered in clinical practice. Previously, the prognosis for such injuries was almost always unfavorable, patients often died. But modern medicine allows in most cases to save lives and restore at least a small part of the lost functions of the spinal cord.

Assistance to the victim must be started immediately, but always correctly. Any erroneous action can be deadly or significantly worsen the recovery process. Therefore, each person needs to know the signs of spinal cord injury, to have an idea about the types of injuries and prognosis regarding recovery.

Symptoms

The spine and spinal cord are arranged very reliably. Under normal conditions, they are almost impossible to damage, therefore, another type of injury, due to which the spinal cord is damaged, is a rather rare occurrence.

This usually happens in emergency situations: a car accident, a natural disaster, a fall from a height, a bullet or knife wound to the spinal cord. The nature of the damage and the chances of a complete recovery of the spinal cord depend on the mechanism of injury.

Any doctor will say that he has never seen two identical injuries of the spine and spinal cord. This is due to the fact that the symptoms and prognosis for spinal cord recovery differ significantly in different patients depending on the severity of the injury, its location, body characteristics, and even mood.

The main differences in the symptoms of a spinal cord injury depend on whether the injury is partial or complete. According to the localization of the consequences, it is possible to determine the level of the spinal cord that was injured. It also matters whether there are open or closed lesions. Below are the symptoms that are typical for most patients with a diagnosis of "injury of the spine and spinal cord".

Partial damage

With partial damage, only part of the brain tissue is injured. Accordingly, some of the functions will be preserved. Therefore, signs of spinal cord injury will gradually decrease if appropriate treatment is provided immediately.

Usually in the first hours it is impossible to assess how severe the injury is and whether there are surviving fibers. This is due to the phenomenon of spinal shock. Then, when it passes, it gradually becomes clear what part of the brain substance has survived. The final result can be seen only after a few months, and sometimes after 1-2 years. In the clinical course, doctors distinguish four periods, their features are listed in the table, which can be seen below:

With different degrees of spinal cord injury, the symptoms and timing of their manifestations may vary slightly. But in any case, during the first three periods, the victim must be in the appropriate medical center. In the later period, it is also important to listen to the guidance of doctors.

Full break

Symptoms of spinal cord injury with its complete rupture in the acute period are also manifested by spinal shock. But in the future, there is no restoration of even a part of the lost functions. The part of the body below the spinal cord injury remains paralyzed. This option is possible for both open and closed injuries.

Unfortunately, at present, a technique has not yet been developed that has made it possible, surgically or otherwise, to restore the connection of the body and limbs with the main part of the central nervous system, if a complete rupture of the brain is observed. Therefore, when confirming such a diagnosis, psychological and emotional problems often arise associated with anxiety about one's future, about one's family, a feeling of helplessness, and social adaptation becomes more difficult.

Classification of injuries

There are several classifications that are used to characterize an injury. The most important thing is to know how and to what extent the spine is damaged and in which place there is a violation of the integrity of the nerve fibers. This can be determined by instrumental examination and inspection.

Different classifications take into account different parameters. Below are the most common characteristics and those that are important to know to understand the severity of the victim's condition.

By location

Depending on the location of the injury, which ones will not be able to fully function. The localization of the injury must be recorded on the medical card in the form of a capital Latin letter and a number. The letter means the spine (C - cervical, T - thoracic, L - lumbar, S - sacral), and the number is the number of the vertebra and the nerve emerging from the corresponding intervertebral foramen.

There is a direct relationship between the nature of disorders and the location of damage to the spine and spinal cord:

Up to 4 cervical vertebrae are the most dangerous injuries. There is no work of all four limbs (central tetraplegia), the functions of the organs located in the pelvic region are completely impaired, usually it is not possible to detect signs of preservation of at least some type of sensitivity below the injury site. With a complete rupture, the work of the heart and lungs stops, a person can live only if he is connected to life support devices.
The lower cervical region (5–7 vertebrae) - there is no sensitivity, paralysis of the legs develops according to the central type, paralysis of the hands according to the peripheral type, severe pain at the site of injury.
At the level of up to 4 chest - a violation of cardiac and respiratory activity, the function of the pelvic organs, radicular pain.
5–9 chest - paresis of the lower extremities with the possibility of maintaining deep sensitivity, disruption of the pelvic organs.
Thoracic region below the 9th vertebra - sensory disturbances of half of the body (lower), flaccid paralysis of the legs.
The lower parts of the spine - sometimes flaccid paralysis of the legs, sensitivity is preserved, although not fully, the functions of the bladder are partially preserved, radicular pain bothers quite often.

But it is worth remembering that the possible degree of recovery depends not only on the location of the damage, but also on its nature. With minor damage and the right approach to rehabilitation, it is possible to achieve better results than the usual indicators for an injury of a similar location.

According to the nature of the damage

Often, when making a diagnosis, the level of damage to the bone structures of the spinal column is also indicated. But the injuries of the vertebrae themselves do not always correspond in severity exactly with the depth of damage to the medulla.

To assess the severity of the condition in relation to the integrity of the nervous structures, it is worth considering such differences in characteristics:

Partial compression by a fragment of a vertebra or other bone structure, a foreign body (may get into the spinal canal if there are not only closed injuries). In this case, the symptoms will depend on which part is most damaged.
Rupture of the spinal cord due to the impact of a sharp object or part of a vertebra, sharp compression (crush), strong stretching in length. The risk of complete rupture is very high if the damaging agent is sharp and large.
Hematomyelia is bleeding into the gray matter that can compress nerve structures and destroy them.

Concussion of the spinal cord - most often occurs when a blow to the back without violating the integrity of the bone structures.
Swelling – may exacerbate symptoms or even cause additional damage. It may be the only consequence of an injury or be combined with mechanical damage.
Spinal injury. Usually happens with a strong impact. The severity of injuries is different, it is assessed after the elimination of symptoms of spinal shock.
Contusion. It also manifests itself as spinal shock, but there are still chances for recovery, although in most cases incomplete.
Spine break. The functions for which he was responsible (mobility or sensitivity) suffer.
The presence of an infection. The risk is not very great if closed lesions are observed. But if there is an open wound, pathogens could easily get there. It is especially dangerous if the object damaging the spinal cord is a non-sterile foreign body.

It is possible to talk about such characteristics only after the examination. But they are very important to take into account when predicting improvements.

Forecast

The prognosis for and spinal cord depends on the characteristics of the injury, the age and health of the patient, the amount of effort that he and the doctors are willing to make to recover. The rehabilitation period is especially important for relatively minor injuries. In this case, with active timely actions, a complete recovery is possible, and in their absence, a worsening of the condition.

It is possible to note the following patterns of the relationship between the nature of injuries and the possibilities of recovery:

Weak damage. For example, when hitting the spinal column, a concussion of the spinal cord is possible. Because of this, its edema may develop, symptoms of a violation of the conduction of the spinal cord develop, but there is no mechanical damage, ruptures of the nervous tissue, fractures of bone structures. In this case, all symptoms disappear within a few days.
Partial damage. When spinal shock develops, an extremely serious condition can be observed, but then the surviving fibers begin to perform their functions again. In addition, sometimes it happens that the surviving areas take on some of the actions that were characteristic of neighboring damaged fibers. Then the mobility and sensitivity of the parts of the body below the site of spinal cord injury can be restored almost completely.
Complete rupture, crush. In this case, only the formation of new reflex reactions is possible, which will be controlled exclusively by the spinal cord.

In any case, whatever the diagnosis, it is important to cooperate with doctors as much as possible in order to prevent the development of undesirable consequences of improper treatment and not to miss all possible chances for recovery. To do this, you can familiarize yourself with the complex of measures that doctors carry out and find out why each action is needed.

Treatment and rehabilitation

How complete the recovery of the spinal cord will be and how many consequences will remain in the future depends on many factors. Of course, it is very important to consider the severity of the injury and not expect a person to be able to move as before the injury if he is diagnosed with a complete rupture of the brain matter. But a responsible approach and competent actions of the surrounding people, doctors and the patient himself can at least save a life. In addition, it was noted that with a positive attitude of the victims, recovery is faster, the indicators at discharge are better, and the consequences of the injury are minimal compared to others.

Since spinal cord injuries are very dangerous, each period of treatment is associated not only with the restoration of health, but also with saving lives in general. Any wrong action can significantly worsen the condition of the victim. Therefore, even for those who are not connected in any way with medicine, it is important to know what is needed and what cannot be done in such situations.

First steps

How complete the restoration of spinal cord function will be depends largely on what will happen in the first minutes after a person has been injured. In most cases, at this time there are people who are not trained to provide first aid in such situations.

Therefore, it is important for everyone to remember two simple rules that always apply when someone is injured and it is impossible to immediately understand how serious his condition is:

Immediately call an ambulance, indicating the details of the reason for the call, the approximate nature of the injury. Be sure to mention that the casualty is unconscious, if so.
Do not touch, do not try to move a person or change his posture, do not remove an object that injures him, especially if it is clear that a spinal fracture has occurred. No one knows what condition his spinal cord is in. With an unsuccessful movement, it is easy to turn a partial injury into a complete tear, thereby depriving a person of the hope of being able to walk again. That is, the harm from wrong actions can be greater than from the injury itself.

The rest of the help should be provided by specialists. They have special equipment and tools that will help deliver a person to the hospital without the risk of worsening his condition, fixing the fracture in a stationary state. They also immediately inject neuroprotectors - substances that prevent the self-destruction of the brain substance, which can occur with spinal shock.

In the hospital

Treatment of spinal cord injuries is carried out exclusively in a hospital setting. The patient is usually in intensive care for several days. When a person regains consciousness, he still needs constant care, which can only be provided in a hospital.

An approximate sequence of actions that is necessary for recovery:

Re-examination (the first is carried out by an ambulance team). The presence of sensitivity and reflexes is checked.
The introduction of painkillers, neuroprotectors, if necessary (for example, if there is an open fracture of the spine), antibacterial drugs.
Insertion of a catheter into the bladder.
In most cases, surgery is indicated with the restoration of bone structures if there is a fracture of the vertebra or its arches.
Care after surgery: massage to prevent contractures, skin care to prevent bedsores, if necessary, assistance with defecation and urination.
Physiotherapy.
Limb exercises, passive or active, depending on the patient's capabilities.

After the patient's condition stabilizes and the patient feels better enough that he does not need constant medical care to restore his health, he is discharged home. This happens no earlier than 3 months later.

Discharge is only the first achievement on the road to recovery. You can't stop there.

After discharge

Rehabilitation after a spinal cord injury is a very lengthy process. It lasts at least a year. During all this time, it is important not to miss any rehabilitation measures that will be offered by doctors. This applies to both physical and social recovery. You will need to get used to the fact that some actions will now need to be done in a completely different way. And sometimes it may be necessary to ask for help from someone close to you.

All improvements that come will be gradual. Sometimes, at the beginning of the recovery period, a person is weakly given movement, even if the necessary nerve fibers are preserved. This is due to the fact that muscles and joints are able to "forget" how to carry out their functions if they have not been used for a long time. You should not be afraid of this, you just need to re-teach them how to work, and after a while the movements will be given without difficulty.

Injury, as a result of which the functions and anatomical integrity of the spinal column and/or spinal cord and/or its great vessels and/or spinal nerve roots were impaired. Clinical manifestations depend on the level and severity of the injury; they can vary from transient paresis and sensory disorders to paralysis, movement disorders, disorders of the pelvic organs, swallowing, breathing, etc. In the diagnosis of injuries of the spine and spinal cord, spondylography, myelography, MRI, CT, and lumbar puncture are used. Treatment of spinal cord injury may include reposition, immobilization, fixation of the vertebrae, decompression of the brain, followed by restorative therapy.

General information

Spinal cord injury is a violation of the anatomical and physiological relationships of the spinal column and the structures of the spinal canal (shells, substance, vessels of the spinal cord, spinal nerves), leading to partial or complete loss of the corresponding functions. In various countries, the frequency of spinal cord injuries varies from 30 to 50 cases per 1 million population. Among the victims, men of young working age (20-39 years) predominate, which determines not only the medical, but also the social significance of the problem. Neurosurgery, neurology and traumatology are engaged in the organization and provision of timely specialized care to victims with spinal cord injury.

The causes of damage to the spine and spinal cord in spinal cord injury can be both direct traumatic effects on the spine, and its mediated injury when falling from a height, in traffic accidents, forced flexion during blockages, etc.

Classification of spinal cord injuries

Spinal cord injuries are divided into isolated, combined (in combination with mechanical damage to other organs and tissues) and combined (in combination with damage to thermal, radiation, toxic and other factors). According to the nature of the damage, spinal cord injuries are divided as follows:

closed (without damage to paravertebral tissues);
open, not penetrating into the spinal canal;
open, penetrating into the spinal canal - through (damage to the spinal canal right through) and blind (injuring the object remains in the spinal canal) and tangential.

Open injuries of the spine can be gunshot (shrapnel, bullet) or non-gunshot (cut, chopped, stab, etc.).

In case of comminuted fractures of the cervical vertebral bodies and their compression fractures with an angular deformity of more than 11 degrees, anterior decompression of the brain is indicated by removing the bodies of the broken vertebrae and replacing them with a bone graft, a cage with bone chips or a porous titanium-nickel implant in combination with a titanium plate or without it. If more than two adjacent vertebrae are damaged, anterior or posterior stabilization is indicated. When the spinal cord is compressed from behind by fragments of a broken vertebral arch, posterior decompression is indicated. If the injury to the spinal segment is unstable, decompression is combined with posterior fusion, preferably with a transpedicular construct.

Stable compression fractures of the thoracic vertebral bodies of type A1 and A2 with kyphotic deformity of more than 25 degrees, leading to anterior compression of the spinal cord by the type of its spreading and tension on the blade, are treated with simultaneous closed (bloodless) reclination in the first 4-6 hours after injury or open reclination and decompression of the brain with interarticular fusion with ties or other structures. Fractured dislocations of the thoracic vertebrae in the acute period are easy to reposition and reclinate, therefore, a posterior approach to the spinal canal is used for decompression of the brain. After laminectomy, external and internal decompression of the brain, local hypothermia, transpedicular fusion is performed, which allows additional repositioning and reclination of the spine.

Given the large reserve spaces of the lumbar spinal canal, decompression of the cauda equina roots is performed from the posterior approach. After removal of compressive substrates, reposition and reclination of the vertebrae, transpedicular fusion and additional correction of the spinal column are performed. After two to three weeks, anterior spinal fusion can be performed with an autobone, cage, or porous implant.

In case of gross deformation of the spinal canal with large fragments of the lumbar vertebral bodies, an anterolateral retroperitoneal approach can be used to reconstruct the anterior wall of the spinal canal and replace the removed vertebral body with a bone graft (with or without a fixation plate), a porous titanium-nickel implant, or a cage with bone chips.

During the rehabilitation period after a spinal cord injury, the patient is treated by neurologists, vertebrologists and rehabilitation specialists. Exercise therapy and mechanotherapy are used to restore motor activity. The most effective combination of physical therapy with physiotherapy methods: reflexology, massage, electrical nerve stimulation, electrophoresis and others.

Prognosis for spinal cord injury

About 37% of victims with spinal cord injury die at the prehospital stage, about 13% - in the hospital. Postoperative lethality with isolated compression of the spinal cord is 4-5%, with a combination of compression of the brain with its contusion - from 15 to 70% (depending on the degree of complexity and nature of the injury, the quality of medical care and other factors). A favorable outcome with complete recovery of the victim with stab and cut wounds of the spinal cord was recorded in 8-20% of cases, with gunshot wounds of the spinal cord - in 2-3%. Complications arising from the treatment of spinal cord injury aggravate the course of the disease, increase the length of stay in the hospital, and sometimes lead to death.

Complex diagnostics and early decompressive and stabilizing operations help to reduce complications and postoperative mortality, improve functional outcome. Modern fixation systems implanted into the spine allow for early activation of patients, which helps prevent the occurrence of pressure sores and other undesirable consequences of spinal cord injury.