How the body recovers after a spinal cord injury. Spinal cord injury: treatment and rehabilitation. Non-traumatic causes of spinal cord injury

Statistically, spinal cord injuries are most often associated with damage to the spinal regions.

According to numerous studies, about 95% of road accidents, various types of accidents and acts of violence in one way or another are the main cause of spinal cord injuries.

At the same time, both men and women aged 20 to 60 years are at greatest risk. And the mortality rate is quite high and disappointing.

Treatment of all types of spinal cord injuries should be carried out immediately, since the preservation and restoration of most functions of the human body directly depends on this factor.

Injuries to the back can have serious consequences that can affect the major motor and nerve regions. It is not uncommon for spinal injuries to result in complete or partial loss of sensory function, as well as disturbances in heart rate and breathing.

However, there are cases when injuries received by a person can only be overcome through long-term combined rehabilitation.

Specially developed programs for such people help not only to find psychological and emotional balance, but to fully adapt to the surrounding everyday and social conditions.

Most common causes of spinal cord injury

The human spinal cord is the main coordination center of the body, which controls all processes in muscles and organs.

It is through it that all systems of the body are informed. Additionally, the structure of the spinal cord is quite unusual.

It is a cylinder with a diameter of 1 to 1.5 centimeters, which is covered with three types of shells: soft, hard and arachnoid.

To protect the brain, dense muscle tissue is intended, which covers the main brain canal.

Currently, medicine classifies three types of spinal cord injuries:

congenital defects and postpartum deviations;
spinal circulation disorder;
fractures, bruises, dislocations due to exposure to external factors.

Despite the fact that the main causes of spinal cord injuries have become quite commonplace in human understanding, they can be divided into the following groups:

Car accidents- this reason is inherent not only to drivers, but also to pedestrians;
Altitude falls- intentional or accidental fall from a certain height level, mainly occurs among athletes;
Domestic and extraordinary injuries- differ in a fairly wide variety, these include falls on ice or from stairs, knife or bullet wounds.

From a medical point of view, spinal injuries are open And closed.

In addition, they can lead to impaired functionality of the spinal cord or its complete rupture.

By nature, spinal injuries are divided into:

shake;
injury;
crushing;
hematomyelia;
Traumatic radiculitis.

Doctors call the most common cases of damage to the back area, in particular the spinal cord, the 1st and 2nd lumbar, 5th and 6th cervical, 12th thoracic vertebrae.

Even minor violations in them can lead to serious and sometimes unpredictable consequences. Irreversible processes in damaged spinal areas are often observed.

The main tools for examination spinal region susceptible to damage are:

Radiography - images of the spinal cord are taken in two projections;

Nuclear magnetic tomography - consists of a detailed examination of all canals and layers of the brain, vertebrae and discs, pressure and swelling.

Spinal shock

This phenomenon is a rupture of transverse sections of the spinal cord due to injury.

Main symptomatic manifestations:

depression of motor and autonomic systems the body in certain segments of the spine;
sudden cessation of control by the central nervous system.

The concept of “spinal shock” has not been fully studied. However, specialists in the treatment and diagnosis of spinal injuries There are several stages of this phenomenon:

first- complete areflexia lasting from 4 to 6 weeks;
second- small reflex movements in the legs and arms, usually lasting from 2 weeks to several months;
third- presence of flexion and extension reflexes.

In order to provide quality and timely first aid to the victim, it is necessary to thoroughly know the main symptoms and signs of this process.

Injuries to the cervical vertebrae are considered the most dangerous for any person.

A characteristic feature of this process is the appearance of acute pain in the neck and limited mobility of the head.

When the spine is fractured, the victim instantly develops paralysis of the limbs or pelvic organs.

Among the basic rules of first aid in such cases are:

The first thing you need to do is call an ambulance.
Make sure the victim is conscious and breathing normally.
If you need to move the injured person, you should lay him down on a flat surface.
Avoid moving a person using a blanket or cloth.
Do not allow the injured spine to bend under any circumstances.
Secure the vertebra with a thick layer of cotton wool or tightly rolled newspaper.
Place pillows or bundles of clothing under your shoulders and neck.
Stay with the victim until medical help arrives.

It is worth remembering that properly provided assistance to someone who has suffered from a spinal cord injury will make it possible to preserve the motor functions of the limbs and the sensitivity of all parts of the body.

Treatment and surgery

The treatment process for various spinal cord injuries must be performed in a neurosurgical hospital.

In this case, this type of treatment should begin with immobilization of the spinal region, especially at the site of injury.

It consists in creating the most comfortable conditions for moving the victim. In addition, it is necessary to take measures to maintain normal blood pressure levels and the functioning of the cardiovascular system.

Most spinal cord injuries require mandatory surgical intervention. It is this method that allows you to eliminate the presence of possible bone fragments, compression of the spinal cord, and swelling of the spinal cord.

In cases of damage to the genitourinary system, it is necessary to unload the urinary tract using all possible methods. For example, insert a catheter into the urethra. And to prevent infection, the bladder is washed with furatsilin in tandem with antibiotics.

At an early stage of diagnosing the extent of damage to the spinal cord injury, the attending physician may offer several treatment options:

Drug treatment - in acute forms of spinal injury, solymedrol is used, which significantly reduces the number of damaged nerve cells and existing inflammatory foci near the site of the injury.
Immobilization- to stabilize the position of the spine, a splint is applied that fixes the body.
Surgical intervention- used when foreign objects or bone fragments or a hernia are found. This method allows not only to eliminate these nuances, but also eliminates the appearance of pain and deformation.

Of course, it is impossible to accurately predict the course of treatment, despite significant scientific strides in the field of neurosurgery. In addition, as practice shows, not in all cases of spinal cord injury, surgery can help in the complete recovery and recovery of the victim.

However, significant hope for a full recovery after spinal injuries is given by use of specific imported metal structures. Carrying out such operations requires special equipment and tools. But this method neurosurgery has already helped patients with minor fractures and dislocations of the spinal cord.

Recovery and rehabilitation

As for activities related to rehabilitation, the following adaptation and restoration methods should be noted:

The use of physical therapy programs based on physical exercise to restore normal strength in the arms and legs.
Treatment with medications to relieve symptoms and complications after injuries, as well as to treat possible urinary tract infections.
Application of specialized wheelchairs to improve the comfort of patients with spinal injuries.
Readaptation of the immediate place of residence consists of constructive changes to the property for high-quality and simple self-service for the victim.

In the fight to restore the performance and normal functioning of a patient with spinal cord injury, doctors take measures that help prevent further damage to the spinal cord, and also make it possible to freely refer the victim to rehabilitation centers where there is real opportunity achieve independence in independent movement.

In such centers it is often used occupational therapy. This type of rehabilitation is developed individually for each case, since both the damage and the rate of recovery are considered unique to each person.

One of the recognized methods of returning functions of the human body lost as a result of injury is considered electrical stimulation. This procedure is not complicated, but it does a good job of getting the main systems up and running.

After the rehabilitation process is completed, the patient must continue to independently work on his own recovery. To do this you need to stay in good shape muscle mass and joint flexibility. Permanent physical exercise and the exercises will undoubtedly have a positive effect on the general physiological state of a person. And he will be able to stand on his feet at the moment when his body is ready for this.

You cannot lose faith in achieving this goal, since the orthopedic consequences of spinal cord injury can be very unpredictable. A person may develop spinal instability, or scoliosis, secondary dislocations, pathological changes in the intervertebral discs and joints, and deformation of the spinal canals.

Video

The video shows an example of recovery from a spinal cord injury.

Life after a spinal cord injury has its own characteristics. This is due to the fact that the immediate process of returning a person to normal life is quite long lasting. The time period for such recovery can range from several months to several years. Therefore, you should be prepared morally and emotionally, and strive to regain all lost body functions.

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 disturbances and damage to 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 sprains, compression, contusions with intracerebral hemorrhage, ruptures or avulsions of one or more nerve roots, as well as infectious lesions and developmental abnormalities. In this article we will look at the symptoms, diagnosis and treatment of spinal and spinal cord injuries. You will learn how pre-hospital care and transportation of a victim with spinal cord injuries are performed.

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

The following causes are considered traumatic:

Non-traumatic causes of spinal cord injuries:

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

Types of injuries

Spinal cord injuries are classified according to various criteria. 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 spinal ligaments;
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 rupture.

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

Compression occurs when vertebral bodies are fractured. It can be partial or complete. Constriction is common in divers; Most often the lower cervical vertebrae are damaged.

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 sacral area.

Compression in 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 occurs.

Common signs of spinal cord problems:

Spinal cord injuries in newborns most often occur in the cervical or lumbar regions. The fact is that the baby’s spinal cord, in comparison with the spine and ligaments, is less extensible and is easily damaged by 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 an x-ray.

Due to neck injury during childbirth, the baby will be in a state of anxiety. The neck may become curved, lengthened or shortened. The infant has the same symptoms as adults: spinal shock, swelling, breathing problems, problems with functioning 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 board. If immobilization is not carried out, bone splinters and fragments will continue to compress the spinal cord, which can be fatal.

The injured person is carried exclusively on a hard surface. If damage to the cervical spine is suspected, the head is additionally fixed using a splint made from improvised means (fabric rollers are suitable).

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

Main rules:

Limit the victim's movements, place him on a hard surface and secure the damaged area using available means.
Give pain medication if necessary.
Make sure the victim is conscious.

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

The disruption extends below the level of damage. During this period, it is impossible to determine a single reflex; only the heart and lungs work. They function autonomously; 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 using electrical impulses to prevent atrophy.

Diagnostics

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

Computed and magnetic resonance imaging give the most detailed picture of the condition of the spine and spinal cord. Here you can see the spinal cord both in longitudinal and cross sections, identify hernias, fragments, hemorrhages, damage to nerve roots and tumors.

Myelography carried out for the purpose of diagnosing nerve endings.

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

Lumbar puncture done to analyze 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 damage. If the injury is mild, the victim is prescribed bed rest, painkillers, anti-inflammatory and restorative drugs.

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

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

IN postoperative period for warning side effects conduct a course intensive care. In this process, the functioning of the cardiac system and breathing 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 to the cervical spine or an orthopedic corset for the treatment of thoracic or lumbar regions.

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

Beds with a raised headboard are also used. When treating the cervical spine, a Gleason loop is used. This is a device in the form of a loop where a head with a cable and a counterweight is attached. Due to the counterweight, gradual stretching occurs.

Drug therapy includes taking anti-inflammatory and painkillers. Drugs are prescribed to restore blood circulation, strengthen the body and activate tissue regeneration processes.

If the victim experiences spinal shock, dopamine, atropine and significant doses of methylprednisolone are used. For pathological muscle stiffness, centrally acting muscle relaxants are prescribed (). To prevent the development of inflammatory phenomena, antibiotics are taken wide range actions.

Rehabilitation

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

The first week of therapeutic training begins with breathing exercises. In the second week, movements with arms and legs are included. Gradually, depending on the patient’s condition, the exercises become more complicated, the body is transferred to a vertical position from a horizontal one, and the range of movements and load are increased.

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

Physiotherapy 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, cellular and tissue metabolism, reduces swelling and inflammatory processes.

Ultrasound, magnetic therapy, general ultraviolet irradiation, electrophoresis with lidase and novocaine, phonophoresis.

Reference. Physiotherapy in combination with medicines improve nutrition and absorption of active substances in tissues and cells.

For paralysis and paresis of the lower extremities, hydrogalvanic baths, underwater shower massage, and mud applications are used. Mud therapy can be replaced with ozokerite or paraffin.

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

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

Complications of spinal cord injury

Complications occur:

in case of untimely provision of medical care;
if the patient violates the discipline of treatment and rehabilitation;
in case of neglect of doctor's recommendations;
as a result of the development of infectious and inflammatory side processes.

A slight bruise, local hemorrhage in the tissues of the spinal cord, compression or concussion does not cause serious consequences; the victim makes a full recovery.

In severe cases - with extensive bleeding, spinal fractures, severe bruises and compression - bedsores, cystitis, pyelonephritis appear.

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

Conclusion

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

Although methods for diagnosing and providing assistance for injuries of the spine and spinal cord were given in the Egyptian papyri and the works of Hippocrates, for a long time a spinal injury with neurological disorders was considered practically a death sentence. Back in the First World War, 80% of those wounded in the spine died within the first 2 weeks. Progress in the treatment of spinal cord injury (SCI), based on an improved understanding of its pathogenesis and the development of radically new treatment methods, began only during the Second World War and in the post-war years. Today, SCI remains a severe, but usually not fatal, type of injury, and a significant contribution to minimizing its consequences is made by the timely and adequate provision of first, qualified and specialized medical care to victims.

Traumatic injuries of the spine and spinal cord are much less common than TBI. In adults, the incidence of SMT is 5 per 100 thousand population per year, in children it is even lower (less than 1 per 100 thousand population per year), but in children SMT is more often associated with polytrauma and is more severe, with a worse prognosis. In Russia, approximately 80% of victims are men under 30 years of age. Since today the majority of victims even with severe STS survive, the number of people with consequences of STS in the population of developed countries is approximately 90 per 100 thousand population (for Russia today this is approximately 130 thousand people, of which 13 thousand are with paraplegia or tetraplegia) . Social significance the problems cannot be overestimated.

The main cause of SMT is road traffic accidents (50% of cases). This is followed by sports injuries and those associated with active recreation (25%, of which 2/3 are injuries to the cervical spine and spinal cord received while diving in a shallow place). Approximately 10% each are industrial injuries and those received as a result of illegal actions, and 5% are received when falling from a height, in natural disasters, etc.

Most often the cervical spine is damaged (55%), less often - the thoracic (30%), even less often - the lumbosacral

Damage to the spinal cord and its roots occurs in approximately 20% of cases of SCI. Such injuries are called complicated.

Damage Level(defeats) spinal cord assessed by the lower segment, in the dermatome of which sensitivity and at least minimal voluntary movements have been preserved. Often, but not always, this level corresponds to the established level of spinal injury. In assessing the level of spinal cord damage, one should not rely on pathological reflexes (Babinsky, Rossolimo, Oppenheim, protective and synkinesis), their reflex arc may occur below the level of complete spinal cord injury.

Highlight complete And incomplete spinal cord injury. With complete damage (group A on the Frankel scale, Table 12.1), there is no sensitivity and voluntary movements below the level of the lesion. Usually in such a situation the spinal cord is anatomically destroyed. With incomplete damage (groups B, C, D on the Frankel scale), disturbances in sensitivity and movement are expressed to a greater or lesser extent; group E corresponds to the norm.

Injuries to the spine and spinal cord are divided into open, in which the integrity of the skin and underlying soft tissues is compromised, and closed, in which these damages are absent. In peacetime, closed

Table 12.1. Spinal Cord Disability Rating Scale (Frankel)

Complete defeat		No voluntary movement or sensation below the level of the lesion
Only sensitivity is preserved		Below the level of the lesion there are no voluntary movements, sensitivity is preserved
Movements intact but non-functional		Below the level of the lesion there are voluntary movements, but without useful function. Sensitivity may or may not be preserved.
Movements are intact and functional		Useful voluntary movements below the level of the lesion are functional. Various sensitivity disorders
Normal motor function		Movements and sensitivity below the level of the lesion are preserved, pathological reflexes are possible

Closed injuries of the spine and spinal cord

Spinal injuries. Closed spinal injuries occur under the influence of excessive flexion, extension, rotation and axial compression. In many cases, a combination of these mechanisms is observed (for example, with the so-called whiplash injury of the cervical spine, when flexion of the spine is followed by its extension).

As a result of the influence of these mechanical forces, various changes in the spine are possible:

Sprain and rupture of ligaments;

Damage to intervertebral discs;

Subluxations and dislocations of the vertebrae;

Vertebral fractures;

Fracture-dislocations.

The following types of vertebral fractures are distinguished:

Fractures of vertebral bodies (compression, comminuted, explosive);

Fractures of the posterior half ring;

Combined with simultaneous fracture of the bodies, arches, articular and transverse processes;

Isolated fractures of the transverse and spinous processes.

It is of fundamental importance to classify spinal injury as stable or unstable. The stability of the spine is understood as the ability of its structures to limit their mutual displacement so that, under physiological loads, it does not lead to damage or irritation of the spinal cord and its roots. Unstable spinal injuries are usually associated with rupture of ligaments, fibrous ring, multiple destruction of bone structures and are fraught with additional trauma to the spinal cord even with minor movements in the affected segment.

It is easier to understand the causes of spinal instability if we turn to the concept of Denis (Fig. 12.1), who identifies 3 support systems (pillars) of the spine: front the supporting complex (column) includes the anterior longitudinal ligament and the anterior segment of the vertebral body; average the column unites the posterior longitudinal ligament and the posterior segment of the vertebral body; rear column - articular processes, arches with yellow ligaments and spinous processes with their ligamentous apparatus. Violation of the integrity of two of the mentioned supporting complexes (pillars), as a rule, leads to instability of the spine.

Rice. 12.1. Denis’s diagram: the anterior, middle and posterior supporting complexes (pillars) of the spine are highlighted; instability of the spinal segment develops when two of them are affected in any combination

Spinal cord injuries. Based on the type of spinal cord injury, it is classified as concussion, bruise, compression And violation of anatomical integrity(partial or complete rupture of the spinal cord); often these mechanisms are combined (for example, a bruise with vascular rupture and hemorrhage - hematomyelia, causing direct damage to the axons and cells of the spinal cord). The most severe form of local damage to the spinal cord is its complete anatomical break with diastasis of the ends at the site of damage.

The degree of damage to the spinal cord and its roots is of primary importance for the fate of the patient. This damage can occur both at the time of injury (which is incurable) and in the subsequent period, when prevention of secondary spinal cord injuries is potentially possible.

Currently, there are no methods to restore the function of anatomically damaged neurons and cells of the spinal cord. The goal of treating STS is to minimize secondary damage to the spinal cord and provide optimal conditions for the restoration of neurons and axons caught in the zone of impaired blood supply - the “ischemic penumbra.”

A frequent and dangerous consequence of spinal cord injury is edema, caused both by an increase in tissue osmotic pressure during the destruction of cell membranes, and by disturbances in venous outflow due to compression of the spinal veins (hematomas, bone fragments, etc.) and their thrombosis. An increase in the volume of the spinal cord as a result of edema leads to an increase in local hypertension and a decrease in perfusion pressure, which, according to the principle of a vicious circle, leads to a further increase in edema, ischemia and can lead to irreversible damage to the entire diameter of the spinal cord.

In addition to the listed morphological changes, functional disorders caused by disturbances at the cellular level are also possible. Such spinal cord dysfunctions regress, as a rule, within the first 24 hours after injury.

Clinical picture of spinal injury. The main manifestation of a spinal fracture is local pain, which increases significantly with load (standing up, bending and even turning in bed). Spinal damage may also be indicated by:

Abrasions and hematomas;

Swelling and local tenderness of soft tissues in the paravertebral region;

Pain on palpation of the spinous processes;

Different distances between the apices of the spinous processes, displacement of one or more of them anteriorly, posteriorly or to the side from the midline;

Angular change in the spinal axis (traumatic scoliosis, kyphosis or lordosis).

With a fracture of the lower thoracic and lumbar spine, even without damage to the spinal cord, intestinal paresis may develop due to a retroperitoneal hematoma (compressing the vessels and nerves of the mesentery).

Clinical picture of spinal cord damage in spinal injury

The clinical symptoms of a complicated spinal fracture are determined by a number of reasons, primarily the level and degree of damage to the spinal cord.

There are syndromes of complete and partial transverse spinal cord lesions.

At complete transverse spinal cord syndrome down from the level of the lesion, all voluntary movements are absent, flaccid paralysis is observed, deep and cutaneous reflexes are not evoked, all types of sensitivity are absent, control over the functions of the pelvic organs is lost (involuntary urination, defecation disorders, priapism); autonomic innervation suffers (sweating and temperature regulation are impaired). Over time, flaccid muscle paralysis can be replaced by spasticity, hyperreflexia, and automatisms in the functions of the pelvic organs are often formed.

Features of the clinical manifestations of spinal cord injury depend on the level of damage. If the upper cervical part of the spinal cord is damaged (C I-IV at the level of the I-IV cervical vertebrae), tetraparesis or spastic tetraplegia develops with the loss of all types of sensitivity from the corresponding level. If there is concomitant damage to the brain stem, bulbar disorders appear (dysphagia, aphonia, respiratory and cardiovascular disorders).

Damage to the cervical thickening of the spinal cord (C V -Th I at the level of the V-VII cervical vertebrae) leads to peripheral paraparesis upper limbs and spastic lower paraplegia. Conduction disorders of all types of sensitivity occur below the level of the lesion. There may be radicular pain in the arms. Damage to the ciliospinal center causes the appearance of Horner's symptom, decreased blood pressure, and slowed pulse.

Trauma to the thoracic part of the spinal cord (Th II-XII at the level of I-IX thoracic vertebrae) leads to lower spastic paraplegia with the absence of all types of sensitivity, loss of abdominal reflexes: upper (Th VII-VIII), middle (Th IX-X) and lower (Th XI-XII).

If the lumbar thickening (L I S II at the level of the X-XII thoracic and I lumbar vertebrae) is damaged, peripheral paralysis of the lower extremities occurs, anesthesia of the perineum and legs downward from the inguinal (pupart) ligament occurs, and the cremasteric reflex falls out.

In case of injury to the conus of the spinal cord (S III-V at the level of the I-II lumbar vertebrae), there is a “saddle-shaped” anesthesia in the perineal area.

Damage to the cauda equina is characterized by peripheral paralysis of the lower extremities, anesthesia of all types in the perineum and legs, and sharp radicular pain in them.

Spinal cord injuries at all levels are accompanied by disorders of urination, defecation and sexual function. With transverse damage to the spinal cord in the cervical and thoracic parts, dysfunction of the pelvic organs appears, such as the “hyper-reflex neurogenic bladder” syndrome. At first after the injury, urinary retention occurs, which can last for a very long time (months). The sensitivity of the bladder is lost. Then, as the segmental apparatus of the spinal cord disinhibits, urinary retention is replaced by spinal automaticity of urination. In this case, involuntary urination occurs when there is a slight accumulation of urine in the bladder.

When the conus of the spinal cord and the roots of the cauda equina are damaged, the segmental apparatus of the spinal cord suffers and the syndrome of “hyporeflex neurogenic bladder” develops: urinary retention with paradoxical phenomena is characteristic.

noi ischuria - the bladder is full, but when the pressure in it begins to exceed the resistance of the sphincters, part of the urine flows out passively, which creates the illusion of intact urinary function.

Defecation disorders in the form of stool retention or fecal incontinence usually develop in parallel with urination disorders.

Damage to the spinal cord in any part is accompanied by pressure sores that occur in areas with impaired innervation, where bony protrusions are located under the soft tissues (sacrum, iliac crests, heels). Bedsores develop especially early and quickly with severe (transverse) damage to the spinal cord at the level of the cervical and thoracic regions. Bedsores quickly become infected and cause the development of sepsis.

When determining the level of spinal cord damage, the relative position of the vertebrae and spinal segments must be taken into account. It is easier to compare the location of the spinal cord segments with the spinous processes of the vertebrae (with the exception of the lower thoracic region). To determine the segment, add 2 to the vertebral number (so, at the level of the spinous process of the third thoracic vertebra the fifth thoracic segment will be located).

This pattern disappears in the lower thoracic and upper lumbar regions, where at the level of Th XI-XII and L I there are 11 segments of the spinal cord (5 lumbar, 5 sacral and 1 coccygeal).

There are several syndromes of partial spinal cord damage.

Half spinal cord syndrome(BrownSequard syndrome) - paralysis of the limbs and impairment of deep types of sensitivity on the affected side with loss of pain and temperature sensitivity on the opposite side. It should be emphasized that this syndrome in its “pure” form is rare; its individual elements are usually identified.

Anterior spinal syndrome- bilateral paraplegia (or paraparesis) combined with decreased pain and temperature sensitivity. The reason for the development of this syndrome is a violation of blood flow in the anterior spinal artery, which is injured by a bone fragment or a prolapsed disc.

Central spinal cord syndrome(more often occurs with a sharp hyperextension of the spine) is characterized mainly by

paresis of the arms, weakness in the legs is less pronounced; Sensory disturbances of varying severity below the level of the lesion and urinary retention are observed.

In some cases, mainly with trauma accompanied by sharp flexion of the spine, lesion syndrome posterior cords spinal cord- loss of deep types of sensitivity.

Damage to the spinal cord (especially when its diameter is completely damaged) is characterized by disturbances in the regulation of the functions of various internal organs: respiratory disorders with cervical damage, intestinal paresis, dysfunction of the pelvic organs, trophic disorders with the rapid development of bedsores.

IN acute stage injury, the development of “spinal shock” is possible - a decrease in blood pressure (usually not lower than 80 mm Hg) in the absence of signs of polytrauma and internal or external bleeding. The pathogenesis of spinal shock is explained by the loss of sympathetic innervation below the site of injury while maintaining parasympathetic innervation (causes bradycardia) and atony of skeletal muscles below the level of injury (causes deposition of blood in the venous bed with a decrease in circulating blood volume).

Clinical forms of spinal cord injury

Spinal concussion is very rare. It is characterized by damage to the spinal cord of a functional type in the absence of obvious structural damage. More often, paresthesia and sensory disturbances below the injury zone are observed, less often - paresis and paralysis, and dysfunction of the pelvic organs. Occasionally, clinical manifestations are severe, up to the picture of complete damage to the spinal cord; The differential diagnostic criterion is complete regression of symptoms within 24 hours.

The cerebrospinal fluid is not changed during a concussion of the spinal cord, the patency of the subarachnoid space is not impaired. Changes in the spinal cord are not detected by MRI.

Spinal cord contusion - the most common type of lesion in closed and non-penetrating spinal cord injuries. A bruise occurs when a vertebra is fractured with its displacement, prolapse of the inter-

vertebral disc, vertebral subluxation. When the spinal cord is contused, structural changes always occur in the substance of the brain, roots, membranes, and vessels (focal necrosis, softening, hemorrhages).

The nature of motor and sensory disorders is determined by the location and extent of the injury. As a result of a spinal cord contusion, paralysis, changes in sensitivity, dysfunction of the pelvic organs, and autonomic disorders develop. Trauma often leads to the appearance of not one, but several areas of injury. Secondary disorders of the spinal circulation can cause the development of foci of softening of the spinal cord several hours or even days after the injury.

Spinal cord contusions are often accompanied by subarachnoid hemorrhage. In this case, an admixture of blood is detected in the cerebrospinal fluid. The patency of the subarachnoid space is usually not impaired.

Depending on the severity of the injury, restoration of impaired functions occurs within 3-8 weeks. However, with severe bruises that cover the entire diameter of the spinal cord, the lost functions may not be restored.

Spinal cord compression occurs when a vertebrae is fractured with displacement of fragments or when there is a dislocation or herniation of an intervertebral disc. The clinical picture of spinal cord compression can develop immediately after injury or be dynamic (increasing with spinal movements) if it is unstable. As in other cases of SMT, symptoms are determined by the level of damage, as well as the severity of compression.

There are acute and chronic compression of the spinal cord. The latter mechanism occurs when the compressing agent (bone fragment, prolapsed disc, calcified epidural hematoma, etc.) persists in the post-traumatic period. In some cases, with moderate compression, after the acute period of SMT has passed, a significant or complete regression of symptoms is possible, but their reappearance in the long term due to chronic trauma to the spinal cord and the development of a focus of myelopathy.

There is a so-called hyperextension injury of the cervical spine(whiplash injury) that occurs when

car accidents (rear impact with incorrectly installed head restraints or their absence), diving, falling from a height. The mechanism of this spinal cord injury is a sharp hyperextension of the neck, exceeding the anatomical and functional capabilities of this section and leading to a sharp narrowing of the spinal canal with the development of short-term compression of the spinal cord. The morphological focus that forms in this case is similar to that of a bruise. Clinically, hyperextension injury is manifested by spinal cord lesion syndromes of varying severity - radicular, partial dysfunction of the spinal cord, complete transverse lesion, anterior spinal artery syndrome.

Hemorrhage in the spinal cord. Most often, hemorrhage occurs when blood vessels rupture in the area of the central canal and posterior horns at the level of the lumbar and cervical thickenings. Clinical manifestations of hematomyelia are caused by compression of the posterior horns of the spinal cord by gushing blood, spreading to 3-4 segments. In accordance with this, segmental dissociated disturbances of sensitivity (temperature and pain) acutely occur, located on the body in the form of a jacket or half-jacket. When blood spreads to the area of the anterior horns, peripheral flaccid paresis with atrophy is detected, and when the lateral horns are affected, vegetative-trophic disorders occur. Very often in the acute period, not only segmental disorders are observed, but also conduction sensitivity disorders, pyramidal symptoms due to pressure on lateral cords spinal cord. With extensive hemorrhages, a picture of complete transverse lesion of the spinal cord develops. The cerebrospinal fluid may contain blood.

Hematomyelia, if not combined with other forms of structural damage to the spinal cord, is characterized by a favorable prognosis. Neurological symptoms begin to regress after 7-10 days. Restoration of impaired functions may be complete, but more often certain neurological disorders remain.

Hemorrhage into the spaces surrounding the spinal cord can be either epidural or subarachnoid.

An epidural spinal hematoma, unlike an intracranial hematoma, usually occurs as a result of venous bleeding (from

venous plexuses surrounding the dura mater). Even if the source of bleeding is an artery passing through the periosteum or bone, its diameter is small and the bleeding quickly stops. Accordingly, spinal epidural hematomas rarely reach large sizes and do not cause severe compression of the spinal cord. The exception is hematomas caused by damage to the vertebral artery during a fracture of the cervical spine; such victims usually die from circulatory disorders in the brain stem. In general, epidural spinal hematomas are rare.

The source of a subdural spinal hematoma can be both the vessels of the dura mater and spinal cord, and the epidural vessels located at the site of traumatic damage to the dura mater. Subdural spinal hematomas are also rare; usually bleeding inside the dural sac is not limited and is called spinal subarachnoid hemorrhage.

Clinical manifestations. Epidural hematomas are characterized by an asymptomatic interval. Then, a few hours after the injury, radicular pain appears with varying irradiation depending on the location of the hematoma. Later, symptoms of transverse compression of the spinal cord develop and begin to increase.

The clinical picture of intrathecal (subarachnoid) hemorrhage in spinal cord injury is characterized by acute or gradual development of symptoms of irritation of the membranes and spinal roots, including those located above the site of injury. Intense pain in the back and limbs, stiffness of the neck muscles, and Kernig's and Brudzinski's symptoms appear. Very often they are accompanied by paresis of the limbs, sensory conduction disturbances and pelvic disorders due to damage or compression of the spinal cord by gushing blood. The diagnosis of hemorrhachis is verified by lumbar puncture: the cerebrospinal fluid is intensely stained with blood or xanthochromic. The course of hemorrhachis is regressive, and complete recovery often occurs. However, hemorrhage in the cauda equina area can be complicated by the development of an adhesive process with severe neurological disorders.

Anatomical spinal cord injury occurs at the time of injury or secondary spinal cord injury

a wounding object, bone fragments, or when it is overstretched and ruptured. This is the most severe type of SMT, since restoration of anatomically damaged spinal cord structures never occurs. Occasionally, anatomical damage is partial, and Brown-Séquard syndrome or another of those described above develops, but more often such damage is complete. Symptoms are determined by the nature and level of the lesion.

Objective diagnosis

Radiography. Direct radiological signs of a spinal fracture include disturbances in the structure of the bodies, arches and processes of the vertebrae (discontinuity of the external bone plate, the presence of bone fragments, a decrease in the height of the vertebral body, its wedge-shaped deformation, etc.).

Indirect radiological signs of SMT - narrowing or absence, less often - widening of the intervertebral space, smoothing or deepening of natural lordoses and kyphosis, the appearance of scoliosis, changes in the axis of the spine (pathological displacement of one vertebra relative to another), changes in the course of the ribs due to trauma to the thoracic region, as well as poor visualization spinal structures in the area of interest even with targeted images (caused by paravertebral hematoma and soft tissue edema).

X-ray examination makes it possible to identify with sufficient reliability bone destructive changes and metal foreign bodies, but provides only indirect, unreliable information about the state of the ligamentous apparatus of the spine and intervertebral discs, about hematomas and other factors of spinal cord compression.

To identify the condition of the spinal cord and its roots, as well as to assess the patency of the spinal subarachnoid space, previously myelography- X-ray examination of the spine after introducing a radiopaque substance into the subarachnoid space of the lumbar or occipital cistern, contouring the spinal cord and its roots. Various preparations were proposed (air, oil and aqueous solutions of iodine salts), the best in terms of tolerability and quality of contrast were non-ionic water solutions.

suitable radiopaque agents. With the advent of CT and MRI, myelography is practically not used.

CT- the main method for diagnosing the condition of the bone structures of the spine. Unlike spondylography, CT is good at detecting fractures of the arches, articular and spinous processes, as well as linear fractures of the vertebral bodies, which do not lead to a decrease in their height. However, before a CT scan, X-ray or MRI of the spine is mandatory, since it allows you to establish “areas of interest” in advance and thereby significantly reduce the radiation dose. Three-dimensional reconstruction of spinal structures obtained from spiral CT helps plan surgical intervention. CT angiography provides visualization of the internal carotid and vertebral arteries, which can be damaged by trauma to the cervical spine. A CT scan may be performed if there are metallic foreign bodies in the wound. The disadvantage of CT is unsatisfactory visualization of the spinal cord and its roots; some assistance in this may be provided by the introduction of a radiopaque substance into the subarachnoid space of the spinal cord (computed myelography).

MRI- the most informative method for diagnosing SMT. It allows you to assess the condition of the spinal cord and its roots, the patency of the spinal subarachnoid space and the degree of compression of the spinal cord. Well visualized on MRI intervertebral discs and other soft tissues, including pathological ones, and obvious bone changes. If necessary, MRI can be supplemented with CT.

The functional state of the spinal cord can be assessed using electrophysiological methods- studies of somatosensory evoked potentials, etc.

Algorithm for providing medical care for spinal cord injury

1. At the scene of injury, as with TBI, the DrABC algorithm works (Danger remove, Air, Breathing, Circulation). That is, the victim must be moved from the place of maximum danger, ensure patency respiratory tract, mechanical ventilation for breathing problems or in patients in stupor and coma and maintaining adequate hemodynamics.

Rice. 12.2. Philadelphia collar; Various modifications are possible (a, b)

If the victim is unconscious and complains of pain in the neck or weakness and/or numbness in the limbs, external immobilization of the cervical spine with a Philadelphia collar (included in the set of external ambulance orthoses) is necessary - Fig. 12.2. The trachea can be intubated in such a patient after applying the specified external cervical orthosis. If damage to the thoracic or lumbosacral spine is suspected, no special immobilization is carried out; the patient is carefully placed on a stretcher and, if necessary, fixed to it.

The main thing at this stage is to ensure arterial normotension and normal arterial blood oxygen saturation, which, as with TBI, prevents the development of secondary consequences of TBI. In the presence of external and/or internal injuries, among other things, compensation for blood loss is necessary.

There is no specific drug treatment for STS. Glucocorticoids may inhibit lipid peroxidation at the site of injury and may reduce secondary spinal cord injury to some extent. There are recommendations for the administration of high doses of methylprednisolone (30 mg per 1 kg of body weight as a bolus in the first 3 hours after SMT, then 5.4 mg per 1 kg of body weight per hour for 23 hours); The effectiveness of this regimen has not yet been confirmed in independent studies. Other previously proposed drugs (“nootropic”, “vascular”, “metabolic”) are ineffective.

2. Inpatient (hospital) stage of medical care. Assessment of the condition of the spine is necessary in all victims with TBI of any severity, in victims with neurological symptoms that appeared after the injury (impaired sensitivity, movements, sphincter function, priapism), in persons with multiple injuries to the skeletal bones, as well as in cases of complaints of back pain in the absence of noticeable damage and neurological deficits.

Victims with clinical manifestations or a high risk of STS (see below) must undergo one or more objective neuroimaging studies.

Algorithm of actions in the emergency room. First of all, the severity of the patient’s condition is assessed using the GCS, hemodynamic parameters and pulmonary ventilation are determined and, if necessary, emergency measures are taken to correct them. At the same time, the presence and nature of combined injuries to internal organs and extremities are assessed, signs of combined damage (thermal, radiation, etc.) are identified and the order of therapeutic and diagnostic measures is determined.

All patients with clinical signs of SMT or in an unconscious state must have a permanent urinary catheter and nasogastric tube installed.

The general rule is to eliminate the most life-threatening factor a. However, even if SMT is not leading in the severity of the patient’s condition or is only suspected, all diagnostic and therapeutic measures should be carried out with maximum immobilization of the spine.

In victims with mild TBI (15 GCS points) in the absence of complaints and neurological symptoms, assessing the condition of the spine using physical methods is sufficient. Obviously, in such victims the likelihood of SMT is extremely low, and the patient can be released under the supervision of a family physician. Neuroimaging studies are usually not performed in these cases.

In the absence of signs of TBI or SCI, but with multiple bone injuries, a thorough neurological and physical assessment of the condition of the spinal cord and spine is necessary. In such a situation, even in the absence of clinical signs of STS, radiography of the cervical spine is advisable, and in patients in serious condition, of the entire spine.

Radiography is performed by most victims (only with closed SMT and, accordingly, confidence in the absence of metallic foreign bodies in the patient’s body, is it possible to refuse radiography in favor of MRI).

In patients with impaired consciousness, radiography of the cervical spine is required in at least a lateral projection

Rice. 12.3. Compression fracture of the VII cervical vertebra with retrolisthesis (“diver’s fracture”); spondylogram, lateral projection: a - before stabilization; b - after it

(Fig. 12.3); For the remaining victims with complaints of back pain or neurological symptoms, radiography of the presumably damaged part of the spine is performed in 2 projections. In addition to radiography in standard projections, if necessary, radiography is performed in special settings (for example, if there is a suspicion of injury to the 1st and 2nd cervical vertebrae, pictures through the mouth).

If radiological signs of spinal damage (direct or indirect) are detected, the diagnosis is verified using MRI or CT (Fig. 12.4). As already mentioned, with closed SMT, it is possible to abandon radiography in favor of MRI.

Rice. 12.4. Fracture of the odontoid process of the II cervical vertebra: a - MRI; b - CT; due to the loss of the supporting function of the odontoid process as a result of a fracture, the first cervical vertebra is displaced anteriorly, the spinal canal is sharply narrowed

Assessment of the functional state of the spinal cord using electrophysiological methods is usually performed in a hospital on a routine basis.

Algorithm of actions in the hospital. After the diagnosis of STS and associated injuries is established, the patient is hospitalized in the department according to the profile of the main (most life-threatening) pathology. From the first hours of SMT with spinal cord injury, complications are prevented, the main of which are bedsores, urinary tract infections, deep vein thrombosis of the legs and pelvis, intestinal paresis and constipation, gastric bleeding, pneumonia and contractures.

Measures to prevent bedsores include the use of an anti-bedsore mattress, hygienic skin care, frequent changes in the patient’s position in bed and, in the absence of spinal instability, early (after 1-2 days) activation of the victim.

Urinary infection develops in almost all patients with spinal cord injury, and the “trigger” is the resulting acute urinary retention, leading to overstretching of the bladder, ureters and renal pelvis, circulatory disorders in their walls and retrograde spread of infection due to vesicoureteral reflux . Therefore, perhaps earlier, such patients undergo catheterization of the bladder with preliminary introduction into the urethra of a solution or gel of an antiseptic and anesthetic (usually chlorhexidine with lidocaine); permanent catheter if possible, remove it after a few days and perform periodic catheterization of the bladder (once every 4-6 hours; to prevent overdistension of the bladder, the volume of urine should not exceed 500 ml).

Deep vein thrombosis of the legs and pelvis develops in 40% of patients with spinal cord injury and often occurs without clinical manifestations, but in 5% of cases leads to thromboembolism pulmonary artery. The greatest risk of deep vein thrombosis is in the first 2 weeks after injury with a maximum on the 7-10th day. Prevention consists of the use of periodic pneumatic compression of the legs and/or stockings with graduated compression, passive exercises and early activation (for stable or surgically stabilized spinal injuries);

in the absence of contraindications, low molecular weight heparin preparations are prescribed.

Intestinal paresis develops in the majority of victims with STS and can be caused by both central and peripheral mechanisms (compression of the mesentery with the vessels and nerves passing through it by a retroperitoneal hematoma that occurs during a fracture of the lumbar and sometimes thoracic spine). Therefore, on the first day, such victims are fed parenterally and then gradually increase the amount of food with sufficient fiber content; If necessary, laxatives are prescribed.

In many patients, on the 1st day after SMT, erosions of the mucous membrane of the stomach and duodenum occur, leading to gastric bleeding in 2-3% of cases. Therefore, victims are given a nasogastric tube and prescribed H 2 blockers (ranitidine, famotidine), taking them during the first 7-10 days reduces the risk of gastric bleeding to 1%.

Violations of pulmonary ventilation are caused by impaired innervation of the intercostal muscles, pain with concomitant rib fractures and immobilization with the development of congestion in the posterior parts of the lungs. Prevention consists of breathing exercises, anesthesia for rib fractures, and early activation of the patient. In case of injury to the cervical spine, there is a need for periodic sanitation of the upper respiratory tract, sometimes using a bronchoscope. Mechanical ventilation is carried out with a periodic increase in end-expiratory pressure; if long-term mechanical ventilation is necessary, a tracheostomy is performed.

Prevention of contractures begins on the 1st day after SMT and consists of active and passive gymnastics at least 2 times a day; To prevent contractures in the ankle joints, the feet are fixed in a flexed position using pillows or external orthoses.

It should be borne in mind that even if immediately after the injury the clinical picture of complete spinal cord damage is determined, in 2-3% of victims, a greater or lesser recovery of impaired functions is observed after a few hours. If the clinical picture of complete spinal cord injury persists after 24 hours from the moment of SMT, the chances of further neurological improvement are extremely low.

Until the nature of the lesion is clarified and an adequate treatment method is selected, external immobilization is maintained. Algorithm for the treatment of spinal cord injury

The treatment algorithm for STS is determined by the nature of the damage to the spine (stable or unstable) and spinal cord (complete or incomplete).

For stable damage indications for urgent surgery rarely arise, only when there is compression of the spinal cord or spinal root. Limiting the load on the affected segment is usually sufficient. To do this, in case of damage to the cervical spine, external orthoses (“head holders”) are used; in case of stable fractures of the thoracic and lumbar spine, various corsets are used or simply prohibiting heavy lifting, bending, and sudden movements for 2-3 months. With concomitant osteoporosis, calcium supplements with ergocalceferol and, if necessary, synthetic calcitonin are prescribed to accelerate fracture healing.

For unstable damage immobilization is necessary - external (using external devices) or internal, carried out during surgery. It should be noted that even with complete damage to the spinal cord and instability of the spine, its stabilization is necessary - this improves the possibilities of rehabilitation.

Treatment of complicated spinal fractures

The main goals that are pursued when providing care to patients with a complicated spinal fracture are the elimination of compression of the spinal cord and its roots and the stabilization of the spine.

Depending on the nature of the injury, this goal can be achieved in different ways:

Surgical method;

Using external immobilization and repositioning of the spine (traction, neck collars, corsets, special fixing devices).

Spinal immobilization prevents possible dislocation of the vertebrae and additional damage to the spinal cord, creates conditions for eliminating existing spinal deformation and fusion of damaged tissues in a position close to normal.

One of the main methods of immobilizing the spine and eliminating its deformation is traction, which is most effective for cervical trauma.

Traction is carried out using a special device consisting of a bracket fixed to the skull and a system of blocks that perform traction (Fig. 12.5).

The Crutchfield clamp is fixed to the parietal tuberosities with two screws with sharp ends. Traction using weights is carried out along the axis of the spine. At the beginning of traction, a small load is usually installed (3-4 kg), gradually increasing it to 8-12 kg (in some cases - more). Changes in spinal deformation under the influence of traction are monitored by repeated radiography.

The disadvantage of traction is the need for the victim to stay in bed for a long time, which significantly increases the risk of developing bedsores and thromboembolic complications. Therefore in Lately Implantable or external immobilizing devices that do not interfere with the patient’s early activation are becoming increasingly common.

In case of damage to the cervical spine, immobilization of the spine can be carried out using a device consisting of a special corset such as a vest, a metal hoop rigidly fixed to the patient’s head, and rods connecting

Rice. 12.5. Skeletal traction for a fracture of the cervical spine using a Crutchfield clamp

wearing a hoop with a vest (halo-fixation, halo vest- rice. 12.6). In cases where complete immobilization is not required for injuries to the cervical spine, semi-soft and hard collars are used. Corsets of a special design are also used for fractures of the thoracic and lumbar spine.

When using external immobilization methods (traction, corsets), it takes a long time (months) to eliminate spinal deformity and heal damaged structures in the required position.

In many cases, this method of treatment is unacceptable: first of all, if it is necessary to immediately eliminate compression of the spinal cord. Then there is a need for surgical intervention.

The purpose of the operation is to eliminate compression of the spinal cord, correct spinal deformity and reliably stabilize it.

Surgery. Apply different kinds operations: with an approach to the spinal cord from behind through laminectomy, from the side or from the front with resection of the vertebral bodies. To stabilize the spine, a variety of metal plates, bone screws, and occasionally wire are used. Resected vertebral fragments are replaced with bone fragments taken from the patient's ilium or tibia, special metal and polymethyl methacrylate prostheses. You should know that stabilizing systems provide only temporary immobilization of the damaged part of the spine for up to 4-6 months, after which, due to osteoporosis around the screws embedded in the bone, their supporting function is lost. Therefore, implantation of a stabilizing system is necessarily combined with the creation of conditions for the formation of bone fusions between the above and underlying vertebrae - spinal fusion.

Indications for surgery for spinal and spinal cord injuries

When determining surgical indications, it is necessary to take into account that the most dangerous spinal cord injuries

Rice. 12.6. Halofixation system

occur immediately at the time of injury and many of these injuries are irreversible. So, if a victim immediately after an injury has a clinical picture of a complete transverse lesion of the spinal cord, then there is practically no hope that an urgent operation can change the situation. In this regard, many surgeons consider surgical intervention in these cases to be unjustified.

However, if there are symptoms of a complete break in the spinal cord roots, despite the severity of the damage, surgery is justified primarily due to the fact that it is possible to restore conductivity along the damaged roots, and if they are ruptured, which is rare, a positive result can be obtained with microsurgical suturing ends of damaged roots.

If there are even the slightest signs of preservation of some of the functions of the spinal cord (slight movement of the fingers, the ability to determine a change in the position of a limb, perception of strong pain stimuli) and at the same time there are signs of compression of the spinal cord (presence of a block, displacement of the vertebrae, bone fragments in the spinal canal, etc.) , the operation is indicated.

In the late period of injury, surgery is justified if compression of the spinal cord persists and the symptoms of its damage progress.

The operation is also indicated for severe deformation and instability of the spine, even with complete transverse damage to the spinal cord. The purpose of the operation in this case is to normalize the supporting function of the spine, which is an important condition for more successful rehabilitation of the patient.

The choice of the most adequate treatment method - traction, external fixation, surgery, a combination of these methods is largely determined by the location and nature of the injury.

In this regard, it is advisable to separately consider the most typical types of injury to the spine and spinal cord.

Cervical spine injury

The cervical region of the spine is the most susceptible to damage and the most vulnerable. Cervical injuries are especially common in children, which can be explained by weakness of the neck muscles, significant extensibility of the ligaments, and large head size.

It should be noted that injury to the cervical vertebrae is more often than other parts of the spine accompanied by damage to the spinal cord (up to 40% of cases).

Damage to the cervical vertebrae leads to the most severe complications and more often than with injury to other parts of the spine, to the death of the patient: 25-40% of victims with injury localized at the level of the 3 upper cervical vertebrae die at the scene of the incident.

Due to the unique structure and functional significance of the 1st and 2nd cervical vertebrae, their damage should be considered separately.

I cervical vertebra(atlas) can be damaged separately or together with the second vertebra (40% of cases). Most often, as a result of injury, the atlas ring ruptures in its different parts. The most severe type of SMT is atlanto-occipital dislocation - displacement of the skull relative to the first cervical vertebra. In this case, the area of transition of the medulla oblongata into the spinal cord is injured. The frequency of this type of SMT is less than 1%, mortality is 99%.

When the second cervical vertebra is damaged (epistrophy), a fracture and displacement of the odontoid process usually occur. A peculiar fracture of the second vertebra at the level of the articular processes is observed in hanged people (“hangman’s fracture”).

The C V -Th I vertebrae account for over 70% of injuries - fractures and fracture dislocations with accompanying severe, often irreversible damage to the spinal cord.

For fractures of the first cervical vertebra, traction by rigid external stabilization using halo fixation is usually successfully used. For combined fractures of the 1st and 2nd cervical vertebrae, in addition to these methods, surgical stabilization of the vertebrae is used, which can be achieved by tightening the arches and spinous processes of the first 3 vertebrae with wire or fixing them with screws in the area of the articular processes. Fixing systems have been developed that allow maintaining a certain range of movements in the cervical spine.

In some cases, to eliminate compression of the spinal cord and medulla oblongata by the broken off odontoid process of the second cervical vertebra, anterior access through the oral cavity can be used.

Surgical fixation is indicated for fracture-dislocations of the vertebrae C In -Th r Depending on the characteristics of the damage, it can be performed using various implanted systems. In case of anterior compression of the spinal cord by fragments of a crushed vertebra, a prolapsed disc, or a hematoma, it is advisable to use an anterior approach with resection of the body of the affected vertebra and stabilization of the spine with a metal plate fixed to the vertebral bodies, with the installation of a bone graft in place of the removed vertebra.

Trauma to the thoracic and lumbar spine

With injuries to the thoracic and lumbar spine, compression fractures. More often, these fractures are not accompanied by spinal instability and do not require surgical intervention.

With comminuted fractures, compression of the spinal cord and its roots is possible. In this case, indications for surgery may arise. To eliminate compression and stabilize the spine, complex lateral and anterolateral approaches, including transpleural ones, are sometimes required.

Conservative treatment of patients with consequences of spinal cord injury

The main thing in the treatment of patients with complete or incomplete spinal cord injury is rehabilitation. The goal of rehabilitation treatment carried out by professional rehabilitation specialists is the maximum adaptation of the victim to life with an existing neurological defect. For these purposes, special programs are used to train intact muscle groups and teach the patient techniques that ensure the maximum level of independent activity. Rehabilitation provides for the victim to achieve the ability to take care of himself, move from a bed to a wheelchair, go to the toilet, take a shower, etc.

Special devices have been developed that allow victims, even with severe neurological impairments, to perform

socially useful features and serve yourself. Even with tetraplegia, it is possible to use tongue-activated manipulators, voice-controlled computers, etc. The most important role is played by the help of a psychologist and social rehabilitation - training in a new, accessible profession.

Methods of conservative and surgical treatment of the consequences of SMT are auxiliary, but sometimes essential.

One of the common consequences of spinal cord injury is a sharp increase in tone in the muscles of the legs and torso, which often complicates rehabilitation treatment.

To eliminate muscle spasticity, drugs that reduce muscle tone (baclofen, etc.) are prescribed. At severe forms spasticity, baclofen is injected into the spinal subarachnoid space using implantable programmable pumps (see Chapter 14 “Functional Neurosurgery”). Surgical interventions described in the same section are also used.

In case of persistent pain syndromes, which more often occur with damage to the roots and the development of adhesions, there may be indications for pain interventions, also described in Chapter 14 “Functional Neurosurgery”.

The effectiveness of many drugs previously used to treat SMT (and TBI) - “nootropic”, “vasodilator”, “rheological”, “metabolic”, “neurotransmitter” - has been called into question by the results of independent studies.

Open injuries to the spine and spinal cord

In peacetime, open wounds with penetration of a wounding object into the cavity of the spinal canal are rare, mainly in criminal SMT. The frequency of such injuries increases significantly during military operations and anti-terrorist operations.

The incidence of military injuries to the spine approximately corresponds to the length of each section and is 25% for the cervical spine, 55% for the thoracic spine and 20% for the lumbar, sacral and coccygeal spine.

Features of mine-explosive and gunshot injuries of the spine and spinal cord are:

Open and often penetrating nature of the wounds;

High frequency and severity of damage to the spinal cord and its roots, caused by the high energy of the traumatic agent (causing shock wave and cavitation);

Long prehospital stage medical care;

High frequency of combined injuries (multiple wounds, fractures, dislocations, bruises, etc.);

High frequency of combined (with burns, compression, potentially radiation and chemical damage) injuries.

The principles of first aid are the same as for any type of injury (DrABC). A special feature is attention to preventing secondary infection of the wound by antiseptic treatment of its edges and applying an aseptic dressing; if there is moderate bleeding, the wound should be packed with a hemostatic sponge containing gentamicin (and then applied with an aseptic dressing).

Transportation of the wounded is carried out according to the same principles. Cervical immobilization is necessary but performed whenever possible. In the absence of a stretcher, it is better to carry a wounded person with suspected STS on a board made of boards, etc.

At the stage of qualified care, anti-shock measures are carried out (if they are not started earlier), stopping bleeding, external immobilization of the damaged part of the spine, primary surgical treatment of the wound, administration of tetanus toxoid, catheterization of the bladder, installation of a nasogastric tube. They determine the leading damage in the clinical picture and ensure prompt transportation of the wounded person to the appropriate specialized or multidisciplinary medical institution (hospital or civilian hospital). Immobilization of the spine during transportation is mandatory.

At the stage of specialized medical care, carried out at a certain distance from the war zone, the algorithm for diagnostic and therapeutic measures for STS is similar to that in peacetime. Peculiarities:

Even if MRI is available, preliminary radiography is required to identify metallic foreign bodies;

The use of glucocorticoids (methylprednisolone or others) is contraindicated;

High incidence of wound liquorrhea and infectious complications;

The rarity of spinal instability.

It should be borne in mind that unnecessarily extensive surgical interventions with resection of bone structures, especially those performed before the stage of specialized medical care, significantly increase the incidence of spinal instability.

Indications for surgery for wartime STS

Tissue damage (primary surgical treatment of the wound is required, in the absence of liquorrhea it is carried out according to the usual principles).

Massive tissue damage with crush areas and hematomas. Excision and closed external drainage are performed to reduce the risk of infectious complications.

Wound liquorrhea. It sharply, approximately 10 times, increases the risk of meningitis with the development of a cicatricial adhesive process, often leading to disability and sometimes death of the victim. To relieve liquorrhea, a wound revision is performed with detection and suturing of the dura mater defect (if it is impossible to compare the edges, a graft from local tissues is sutured into the dura mater defect) and careful layer-by-layer suturing of the wound (preferably with absorbable polyvinyl alcohol sutures). Sutures on the dura mater can be strengthened with fibrin-thrombin compositions.

Epidural hematoma. In the absence of the possibility of objective diagnosis, the likelihood of developing an epidural hematoma is indicated by the increase in local neurological symptoms that began several hours after the injury. The operation significantly improves the prognosis.

Compression of the nerve root(s) by a wounding agent or hematoma, bone, cartilage fragments, etc. It manifests itself as pain in the area of innervation of the root and motor disturbances. The operation is indicated even with the assumption of complete anatomical damage, because the ends of the roots can sometimes be compared and sutured; in any case, decompression usually leads to the disappearance of pain.

Damage to the roots of the cauda equina. To decide on surgery in this case, it is desirable to verify the nature of the damage using CT or MRI, but even in the case of an anatomical break, microsurgical suturing of the roots can be beneficial; The greatest difficulty is in identifying the ends of the torn roots, which is problematic even in peaceful conditions.

Damage to blood vessels (vertebral or carotid arteries) is an absolute indication for surgery, during which it is possible to remove the accompanying epidural hematoma.

The presence of a copper-jacketed bullet in the spinal canal. Copper causes an intense local reaction with the development of a scar-adhesive process. It should be understood that the type of bullet can be established in case of criminal wounds in peacetime during operational search activities; during hostilities this is very problematic.

Spinal instability. As mentioned, it is rare with gunshot and mine-explosive wounds; If there is instability of the spine, its stabilization is required. In cases of open wounds, external stabilization (halo-fixation or other) is preferable, since implantation of a stabilizing system and bone grafts significantly increases the risk of infectious complications.

Compression of the spinal cord with the clinical picture of incomplete damage. As already mentioned, due to the high energy of the traumatic agent, even anatomically incomplete spinal cord damage in these situations is usually severe, and the prognosis for recovery is unfavorable. However, if there is at least minimal preservation of neurological function below the level of compression, decompressive surgery is sometimes beneficial.

To prevent infectious complications in case of penetrating wounds, reserve antibiotics are immediately prescribed - imopenem or meropenem with metrogyl, tetanus toxoid is necessarily administered (if not previously administered), and if an anaerobic infection is suspected, hyperbaric oxygenation is performed.

Indications for surgical treatment in the long-term period of gunshot and mine blast wounds are:

Pain syndromes - in order to eliminate them, devices are implanted for delivering painkillers to the central nervous system or systems for analgesic neurostimulation (see section “Functional neurosurgery”).

Spasticity - the same treatment methods are used as for closed SMT.

Migration of a traumatic agent with the development of neurological symptoms (rare).

Spinal instability. More often caused by inadequate primary surgical intervention(laminectomy with resection of articular processes). Requires surgical stabilization.

Lead intoxication (plumbism). A very rare condition caused by the absorption of lead from a bullet located in the intervertebral disc. Lead bullets encapsulated anywhere outside the joints do not cause lead toxicity. Manifested by anemia, neuropathy (motor and/or sensory), intestinal colic. The operation involves removing the bullet; usually performed under X-ray television control. To accelerate the removal of lead residues from the body, calcium trisodium pentetate is used in a high dose (1.0-2.0 g intravenously slowly every other day, a total of 10 to 20 injections).

Rehabilitation of victims does not differ from that for other types of SMT. Psychological rehabilitation for wartime STS is less complex (due to obvious motivation), but physical rehabilitation tends to be a more significant challenge due to the greater severity of the neurological deficit.

Of great importance for the psychological and social adaptation of persons with the consequences of SMT of any origin are public opinion and state policy of assistance to persons with disabilities. physical capabilities. Similar programs have now achieved great success in developed countries.

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

Spinal injuries: prevalence, causes and consequences

Prevalence of spinal injuries

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 injuries are observed with equal frequency in both men and women.

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

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

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

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

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

Anatomical structure of the spine and spinal cord

Anatomy of the spinal column

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

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

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

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

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

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

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

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

Anatomy of the spinal cord

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

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

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

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

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

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

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

Classification of spinal injuries

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

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

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

In addition, great clinical significance distinguishes between stable and unstable injuries.
Unstable spinal injury is a condition in which the resulting deformity may worsen in the future.

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

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

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

Symptoms of spinal injuries

Symptoms of Stable Spinal Injuries

Stable spinal injuries include contusion, distortion (rupture of ligaments without displacement), fractures of the spinous and transverse processes, and whiplash injuries.

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

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

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

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

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

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

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

Signs of mid- and lower-cervical spine injuries

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

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

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

Symptoms of thoracic and lumbar spine injuries

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

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

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

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

Separately, we should highlight compression fractures that occur as a result of load along the axis of the spine (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). With such fractures, a vertical crack forms in the vertebral body. The severity of the lesion and treatment tactics 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 dorsi muscles (muscle ridges located on the sides of the spine) and abdomen is expressed. The latter circumstance requires differential diagnosis with damage to internal organs.

Signs of spinal cord damage

Movement disorders

Motor disorders in spinal cord injuries, as a rule, are symmetrical. Exceptions include puncture wounds and cauda equina injuries.

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

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

Sensory disorders

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

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

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

Visceral-vegetative disorders

Regardless of the location of the damage, visceral-vegetative disorders manifest themselves primarily in disturbances in the functioning of the pelvic organs (retention of stool and urination). In addition, with high damage, there is a mismatch in the activity of organs digestive tract: increasing the secretion of gastric juice and pancreatic enzymes while reducing the secretion of intestinal juice enzymes.

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

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

Treatment of spine and spinal cord injuries

Basic principles of treatment of spinal cord and spinal cord injuries: 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 repeat courses rehabilitation.

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

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

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

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

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

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

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

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

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

Rehabilitation after spinal and spinal cord injuries

Recovery from spinal injuries is a rather lengthy process.
For spinal injuries not complicated by damage to the spinal cord, exercise therapy is indicated from the first days of the injury: first it consists of breathing exercises, and from the second week, limb movements are allowed. The exercises are gradually made more difficult, focusing on the general condition of the patient. In addition to exercise therapy, massage and thermal procedures are successfully used for uncomplicated spinal injuries.

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

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

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

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

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

Spinal cord - This 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 as a bony structure that protects the spinal cord from various injuries.

Thirty-one spinal nerves extend from the spinal cord to the chest, abdomen, legs, and arms. These nerves tell 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 - sensations of pain, temperature, body position, etc.

Causes of spinal cord injury

road traffic injuries
falling from height
sports injuries
brain tumor
infectious and inflammatory processes
vascular aneurysm
long-term decrease in 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 may be the result of more than one process: spinal injuries, circulatory disorders, infections, tumors, etc.

Spinal cord injuries

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

Location of 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, such damage causes greater paralysis. For example, fractures of the upper spine, especially the first and second cervical vertebrae, lead to damage 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 part of the torso can paralyze.

Degree of damage.

There are different degrees of 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 was damaged in this case.

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 retain sensitivity, but only to some extent. And also certain motor functions below the affected area are preserved.

Complete spinal cord damage. With complete, there is a complete or almost complete loss of motor function, as well as sensitivity below the affected area. But it must be said that the spinal cord, even with complete damage, will not be cut. But only the spinal cord that has been partially damaged can be restored, while a completely damaged brain cannot be 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 bladder and bowels
mild cough, difficulty breathing
changes in sexual and reproductive functions

Critical symptoms

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