Change of cervical department of a backbone – violation of integrity of one or several cervical vertebras as a result of traumatic influence. There are owing to blow, falling on the head, sharp bending or extension of a neck. It is shown by neck pains, restriction of movements and spastic tension of muscles. Often the neurologic symptomatology of various degree of expressiveness comes to light. The diagnosis is exposed on the basis of data of a X-ray analysis, if necessary in addition appoint KT and MPT. Treatment more often conservative, at injury of a spinal cord is required operation.
Change of cervical department of a backbone
Fractures of cervical vertebras make about 30% of total of spinal fractures. At the same time in 40-60% of cases injury of a spinal cord of this or that severity is observed. About 30% of patients with such changes perish on the place owing to shock, and also the heavy violations of breath and warm activity caused by damage of nervous structures. The main part of patients with changes of cervical department of a backbone – active people of young and middle age.
Falling on the head about heights, diving in water in insufficiently deep places, sharp bending (is more rare – extension) necks at sudden braking of transport or heading about a car roof at movement along the bad road becomes the trauma reason usually. Most often compression changes IV, V and VI vertebras come to light, however the most serious consequences arise at fractures of I and II vertebras. Treatment of changes of cervical department of a backbone is performed by traumatologists.
The I cervical vertebra (Atlas) has an appearance of a ring and is peculiar "basis" on which the head keeps. It is jointed by the concave surfaces with convex condyles of an occipital bone, forming a joint with thin cartilaginous surfaces, the capsule and sheaves. Between an occipital bone and the I cervical vertebra there is no thick cartilaginous laying (an intervertebral disk) therefore at heading the injuring force is transferred on the Atlas without depreciation.
Condyles of an occipital bone are pressed into the Atlas's ring, at the same time, depending on expressiveness and an axis of application of the injuring force there can be several types of changes. The change of a forward arch – the isolated damage of a forward half ring, can be followed by more or less expressed shift of otlomk. A change of a back arch – the isolated damage of a back half ring, usually steady, without the essential shift and a sdavleniye of nerves. Changes of side masses – the violation of integrity of the central departments of a ring which is followed by decrease in height of a vertebra.
The heaviest damage of the Atlas is the "bursting" change or a change of Jefferson at which integrity of a ring of the Atlas is broken in four points at once. There are also options of the "bursting" change at which there is an explosive damage of an either a forward, or back arch of the Atlas or parallel changes of back and forward arches. The trauma of the Atlas can be isolated or be combined with injury of the II cervical vertebra and other vertebral segments.
The patient is disturbed by feeling of instability of a neck, neck pain, a darkness and a nape, loss of sensitivity in parietal and occipital area is possible. The patient holds the head with hands. At damage or a sdavleniye of nervous structures the neurologic symptomatology comes to light. The X-ray analysis of the I cervical vertebra in a special projection (through a mouth) allows to confirm violation of integrity of the Atlas and to estimate degree of shift of arches. If necessary in addition appoint KT. Patients with suspicion on damage back or a medulla are examined by the neurosurgeon or the neurologist.
Change of an aksis
The II cervical vertebra () also has the ring form. In forward departments of this ring there is a massive bone outgrowth called by tooth. Tooth connects to a back surface of the Atlas, forming Kryuvelye's joint. Besides, the Atlas and are jointed among themselves by means of the wide and flat symmetrically located articulate surfaces. The toothlike shoot usually suffers because of features of a structure of the top departments of a backbone at injuries. Fractures of tooth of three types can come to light. The first type – detachable damage of a top of tooth, seldom found stable change. The second type – damage of a narrow part of tooth, an unstable change, is observed more than in 50% of cases. The third type – damage of the basis of tooth, in 20% of cases is followed by neurologic violations.
Taking into account degree of removal of the Atlas and expressiveness of symptomatology allocate three degrees of a change of a toothlike shoot. At the first degree shift is absent, the patient shows complaints to unpleasant feelings in a neck and insignificant pains at the movements of the head. At the second degree the Atlas and tooth kpered are displaced, and back part I of a vertebra squeezes a spinal cord. Loss of consciousness is possible during a trauma or after a while after it, the neurologic symptomatology – from insignificant violations of sensitivity to paresis and paralyzes comes to light. At the third degree because of considerable shift usually there are heavy damages of nervous structures, incompatible with life.
It is necessary to consider that false wellbeing at changes of the first degree can provoke underestimation of weight of damage (both the doctor, and the patient). The patient freely moves, turns the head, shakes the head etc. At such movements sometimes there is sharp removal of the Atlas and the sudden compression of a spinal cord which is followed by a sharp compression miyelopatiya and sharp deterioration in a condition of the patient. Taking into account this circumstance all changes of an aksis should be considered as potentially dangerous damages.
For confirmation of the diagnosis carry out a X-ray analysis in two projections: side and through a mouth. At uncertain results carrying out functional pictures is possible (with the maximum care and in the presence of the doctor), however safer and informative method of a research is axial KT with frontal and sagittalny reconstruction. At neurologic violations appoint consultation of the neuropathologist or neurosurgeon.
Fractures of the lower cervical vertebras
The compression and shattered changes of cervical department of a backbone in most cases arise at the forced bending of a neck (sgibatelny changes). Less often damages owing to sharp extension of a neck (razgibatelny changes) meet. Patients complain of pains in cervical department of a backbone. The movements are limited. Spastic reduction and tension of muscles of a neck is defined. The palpation of an awned shoot of the broken vertebra is painful.
In some cases (at a rupture of sheaves between awned shoots) the curvature of the line of awned shoots in the form of a bayonet or a lightning comes to light. This sign testifies to instability of a change. Compression changes usually are not followed by injury of a spinal cord, at the same time unsharply expressed neurologic symptomatology caused by hypostasis of the struck area can be observed. At injury of a spinal cord (arises at the shattered changes and perelomovyvikha more often) neurologic violations are expressed more brightly, in hard cases the tetraplegiya, violation of the act of defecation and an urination comes to light.
Especially heavy damages are perelomovyvikh of cervical vertebras which also usually arise owing to sharp bending of the head. At perelomovyvikha simultaneous injuries of several vertebras, changes of handles, awned and articulate shoots often are found, there are full paralyzes and loss of sensitivity more often. The lethal outcome right after damage, in several hours or several days is possible. In the latter case breath violations, hypostasis of lungs and other complications become a cause of death.
At diagnosis the X-ray analysis of cervical department of a backbone has crucial importance. The side picture in which the compression (decrease in height of forward departments of a vertebra) and increase in an interval between awned shoots of the broken and overlying vertebras can come to light is especially informative. In doubtful cases appoint backbone KT in cervical department, for assessment of a condition of myagkotkanny structures use backbone MRT. In the presence of neurologic violations consultation of the neurosurgeon or neuropathologist is shown.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
In most cases at fractures of cervical vertebras conservative treatment is shown. Patients are hospitalized in traumatologic office. At uncomplicated changes without shift carry out an immobilization with use of a collar as Shants, a plaster corset or a rigid collar for up to 4 months. In the presence the shift and danger of injury of a spinal cord apply extension by Gleason's loop in combination with the correcting pillows or rollers.
At sgibatelny changes the pillow under the head is not put, under shoulders enclose the roller. At razgibatelny damages use two pillows enclosed under the patient's head after elimination of a compression of a pillow remove. In 15-30 days extension is removed and impose a rigid collar or a plaster semi-corset for a period of 3-4 months. Sick appoint anesthetics, physiotherapeutic procedures and remedial gymnastics.
Surgical interventions carry out at unstable fractures and perelomovyvikha of cervical vertebras (especially in a combination to a sdavleniye or injury of a spinal cord), splintered compression changes, and also at inefficiency of conservative treatment. Laminar counteractors, transarticulary clamps or plates apply to fixing of vertebras. In the postoperative period appoint antibiotics, analgetics, LFK, massage and physiotherapy, in the subsequent hold rehabilitation events.