Incomplete dislocation of a cervical vertebra – the pathological state which is followed by the partial shift of articulate surfaces of cervical vertebras relatively each other. Most often the Atlas (the first cervical vertebra) suffers. Not coordinated reduction of cervical muscles, pressure or blow to the head can become the reason of development. It is shown by neck pains, the compelled position of the head, dizzinesses, violations of sensitivity and movements of a trunk and extremities. The diagnosis is specified on the basis of a X-ray analysis, KT and MPT. Treatment is conservative.
Incomplete dislocation of a cervical vertebra
Incomplete dislocation of a cervical vertebra – the partial shift of articulate surfaces of two next vertebras. Can arise owing to blow, falling or sharp turn of the head. Sometimes remains not diagnosed. The most widespread in traumatology is the rotational incomplete dislocation of the Atlas (C1) making about 30% of total number of damages of cervical department of a backbone. As a rule, incomplete dislocations of vertebras are the isolated trauma. At adequate therapy an outcome favorable.
In some cases (usually when falling from height) incomplete dislocations of the II cervical and underlying vertebras are combined with other traumatic damages: fractures of vertebras, ChMT, fractures of bones of extremities, injury of a thorax, stupid injury of a stomach etc. In the presence of the combined damages, especially – ChMT and fractures of vertebras the forecast worsens, and the probability of emergence of neurologic complications increases. Traumatologists are engaged in treatment of the isolated incomplete dislocations. At identification of the accompanying neurologic symptomatology of patients transfer to the jurisdiction of neurosurgeons.
The sharp not coordinated turn of the head becomes the reason of an incomplete dislocation of the Atlas at children's age usually. The trauma arises during physical education classes, active games or sports activities, is more rare – at the first movement after a condition of rest (for example, after a dream). Besides, both at children, and at adults the incomplete dislocation of C1 can develop owing to external passive or active impact on the head or a neck (for example, at blow by a volleyball during the game). At adults rotational incomplete dislocations of the Atlas come to light considerably less than at children.
C1 incomplete dislocation reason newborns can have even an insignificant trauma at advance on patrimonial ways. The tendinous and copular device of babies still insufficiently mature therefore with a considerable amplitude of movements of a sheaf can stretch and be broken off. If during the movement on patrimonial ways the head deviates the central axis of a body, pressure of patrimonial ways can cause dislocation of one vertebra concerning another. Such damages rather often remain not distinguished.
The incomplete dislocation of other cervical vertebras usually results from rather intensive trauma, for example, of falling on the inclined head. Diving on shallow water, heading, falling on the head or on the person, collapses in mines, incorrectly executed somersaults, violation of the equipment at a rack on the head, falling during skating, blow by a nape during a vis on a crossbeam etc. can become the reason of damage. Sometimes the bilateral incomplete dislocation of vertebras develops at the hlystovy mechanism of a trauma – excess sharp bending of a neck with its subsequent extension or, on the contrary, power reextension with the subsequent intensive bending.
At an incomplete dislocation pains in cervical department of a backbone, the compelled position of the head, morbidity are usually observed at a palpation, tension of muscles and hypostasis of soft tissues of neck. Besides, at a sdavleniye of nervous backs and a spinal cord there can be dizzinesses, sleep disorders, headaches, spasms in hands, back, shoulders, lower or top jaw pains, noise in ears, feeling of goosebumps in fingers, decrease in volume and force of movements in the top and lower extremities.
The following signs are characteristic of a rotational incomplete dislocation of C1: pain in the top departments of a neck, turn of the head aside (at a right-hand incomplete dislocation – to the left, at left-side – to the right), sharp strengthening of pain in attempt of movements, impossibility to turn the head in the sick party. Dizzinesses and loss of consciousness are in some cases observed. At incomplete dislocations of C2-C3 there are neck pains, difficulty of swallowing and feeling of puffiness of language. Incomplete dislocations of the lower cervical vertebras are shown by the neck pains irradiating in a shoulder. Perhaps also an abdominal distension, pains or unpleasant feelings behind a breast.
Congenital incomplete dislocations of cervical vertebras in the first months of life often proceed asymptomatically. At increase in vertical loadings (standing and walking) there is a need to carry out the difficult movements, including – and in cervical department of a backbone, and pathology is quite often shown in violation of development of stereotypes of gait (the wrong gait). In the remote period at such children headaches, deficiency of attention, a memory impairment, bystry fatigue and the raised capriciousness can be noted.
The main tool method of diagnostics of an incomplete dislocation of cervical vertebras is the backbone X-ray analysis with use as standard (side and direct), and additional projections: slanting pictures, pictures through a mouth, roentgenograms in the provision of extension and bending of a neck. The list of the additional projections appointed in each case is defined with the presumable level of damage. Along with a X-ray analysis can be appointed KT and MPT.
On KT of a backbone reduction of height of a disk and shift of articulate surfaces comes to light, and at C1 incomplete dislocation – asymmetry between the Atlas and tooth. Carrying out MRT of a backbone allows to specify a condition of soft fabrics. Besides, to patients with suspicion appoint consultation of the neurologist for identification of possible neurologic violations to an incomplete dislocation of vertebras. At old incomplete dislocations and suspicion on deterioration in blood supply of a brain the rheoencephalography is shown.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
At an injury of a neck it is necessary to immobilize the head and the victim's neck completely. If the victim is in the car, it is necessary to record at first reliably a neck, and already then to get it from the vehicle. Use special tires to fixing. In the absence of tires it is possible to use a self-made collar from several layers of the cotton wool wrapped in a gauze, the main thing – that it reliably fixed the damaged department and at the same time did not interfere with breath. Independent reposition of an incomplete dislocation is strictly forbidden, only the qualified specialist in the conditions of a hospital can carry out manipulation.
It is desirable to carry out the procedure in early terms as eventually hypostasis of soft fabrics accrues, and reposition of an incomplete dislocation becomes difficult. Gleason's loop is usually applied. The patient is stacked on a back with a small flat pillow under shoulders. Perhaps as gradual reposition with use of small freight, and one-stage manipulation during which the traumatologist by means of a loop carries out draft and then makes a head turn.
At the time of reposition the characteristic quiet click is heard, the patient notes reduction of pain and disappearance of an obstacle to the movements. Because of damage of the copular device after reposition there can easily be a repeated incomplete dislocation therefore to the patient forbid to move the head and impose Shants's collar or a kraniotorakalny bandage for a period of 2 weeks up to 3 months (depending on level and character of an incomplete dislocation). After reposition surely carry out a control X-ray analysis.
In the subsequent use medicinal therapy, physiotreatment, massage and LFK. According to indications for relaxation of muscles of a neck appoint , for normalization of activity of nervous system and improvement of blood circulation – group B vitamins, for microcirculation improvement – . Massage can be applied from the first days after a trauma, its purpose – relaxation of muscles, improvement of food and blood supply of fabrics. Mainly sparing techniques – strokings and grindings are used.
Occupations of LFK begin right after reposition and continue up to recovery. At the initial stage carry out only exercises for shoulders and nadplechiya. After removal of a collar of Shants add the movement to a complex a neck. All exercises need to be done carefully and accurately, gradually increasing loading. Along with the occupations of LFK apply physiotherapeutic recovery techniques: an electrophoresis with novocaine, ultrasound and thermal procedures.