Spine injury – traumatic damage of the structures forming a spine column (bones, ligaments, a spinal cord etc.). Arises owing to falling from height, road, industrial and natural disasters. Manifestations depend on features of a trauma, the most typical symptoms are pain and restriction of movements. At injury of a spinal cord or nervous backs the neurologic symptomatology comes to light. The diagnosis is specified, using a X-ray analysis, MPT, KT and other researches. Treatment can be both conservative, and quick.
Spine injury – the widespread damage making 2-12% of total of injuries of the musculoskeletal device. At young and middle age men, in elderly – women suffer more often. At children of a spine injury come to light less than at adults. Usually intensive traumatic influence becomes the reason, however at elderly people of injury of a backbone can arise even at an insignificant trauma (for example, at usual falling of the house or on the street).
Consequences depend on features of a spine injury. The considerable share of damages is made by severe defeats. Statistically, about 50% of total number of injuries come to an end with an exit to disability. At injuries of a spinal cord the forecast even more adverse – from 80 to 95% of patients become disabled people, approximately in 30% of cases the lethal outcome is observed. Treatment of spine injuries is performed by traumatologists, vertebrolog and neurosurgeons.
The spine column consists of 31-34 vertebras. At the same time 24 vertebras connect among themselves to the help of mobile joints, and the others grow together and form two bones: sacrum and tailbone. Each vertebra is formed by the massive body and the arch located behind lying ahead. Arches of vertebras are a receptacle for a spinal cord. Each vertebra, except I and II cervical, has seven shoots: one awned, two cross, two top and two lower articulate.
Between bodies of vertebras elastic intervertebral disks are located, and the top and lower articulate shoots of the next vertebras are connected by means of joints. Besides, the spine column is strengthened by sheaves: back, forward, nadostisty, interspinal and mezhduzhkovy (yellow). Such design provides an optimum combination of stability and mobility, and intervertebral disks will amortize loads of a backbone. I and II cervical vertebras have an appearance of rings. The second vertebra is supplied with a toothlike shoot – a peculiar axis on which the head together with the first vertebra rotates concerning a trunk.
In handles of vertebras there is a spinal cord covered with three covers: soft, firm and arachnoid. In verkhnepoyasnichny department the spinal cord is narrowed and comes to an end with the terminal thread surrounded with a bunch of backs of spinal nerves (a horse tail). Blood supply of a spinal cord is carried out by a lobby and two back spinal arteries. It is established that small branches of these arteries are distributed unevenly (one sites have the rich collateral network formed by several branches of an artery others are supplied with blood from one branch) therefore not only direct destructive impacts, but also violations of local blood circulation owing to a gap or a sdavleniye of an artery of small diameter can become the reason of damage of some sites of a spinal cord.
Reasons of spine injuries
In most cases spine injuries result from intensive influences: road incidents, falling from height, collapses (for example, collapses of overlappings of the building at earthquakes, blockages in mines). An exception – damages which appear against the background of the previous pathological changes of a backbone, for example, of osteoporosis, primary tumor or metastasises. In similar cases the spine injury is quite often formed owing to usual falling, blow or even awkward turn in a bed.
As a rule, the type of a spine injury can be predicted on the nature of influence. So, at the road accidents at the driver and passengers the hlystovy trauma – the damage of cervical department of a backbone caused by sharp bending or extension of a neck during emergency brake application or blow in the car behind quite often comes to light. Besides, the cervical department of a backbone suffers at a trauma of the diver – a diving headfirst in insufficiently deep place. When falling from height the combined trauma is often observed: change of nizhnegrudny department of a backbone, change of a basin and fracture of calcaneal bones.
Classification of spine injuries
Depending on existence or absence of wound of a spine injury divide on closed and opened. Taking into account the level of damage allocate injuries of lumbar, chest and cervical department. Taking into account the nature of damage distinguish:
- Backbone bruises.
- Distortions (gaps or anguishes of articulate bags and sheaves without the shift of vertebras).
- Fractures of bodies of vertebras.
- Changes of arches of vertebras.
- Changes of cross shoots.
- Changes of awned shoots.
- Perelomovyvikh of vertebras.
- Dislocations and incomplete dislocations of vertebras.
- Traumatic (shift of an overlying vertebra in relation to underlying as a result of injury of ligaments).
Besides, in clinical practice allocate stable and unstable spine injuries. Stable damages – such which do not pose a threat in respect of further aggravation of traumatic deformation at unstable damages deformation can be aggravated. Unstable spine injuries arise at simultaneous violation of integrity of back and forward structures of vertebras, carry perelomovyvikh, incomplete dislocations, dislocations to number of similar damages and .
The extreme clinical importance has the division of spine injuries into two big groups accepted in traumatology: uncomplicated (without injury of a spinal cord) and complicated (with injury of a spinal cord). Allocate three types of injuries of a spinal cord:
- Reversible (concussion).
- Irreversible (contusion, bruise).
- Sdavleniye of a spinal cord (a compression miyelopatiya) - arises because of hypostasis, a hematoma, pressure of the damaged soft tissues or fragments of vertebras; it is quite often formed under the influence of at once several factors.
Symptoms of spine injuries
The bruise of a backbone is shown by the poured morbidity, hypodermic hemorrhages, a swelling and insignificant restriction of movements. At a distortion in the anamnesis the sharp raising of weights usually comes to light. The patient shows complaints to an acute pain, the movements are limited, morbidity at a palpation of cross and awned shoots is possible, the radiculitis phenomena are sometimes observed. At changes of awned shoots in the anamnesis the blow or sharp reduction of muscles is noted, the victim complains of moderate pain, the palpation of the broken shoot is sharply painful.
At changes of cross shoots there is poured pain. Payr's symptom (the local pain in okolopozvonochny area amplifying at turn of a trunk to the opposite side) and a symptom of the stuck heel (impossibility to tear off from a surface the straightened leg on the party of defeat in a prone position on a back) comes to light. At hlystovy injuries there is neck and head pain, the sleep of extremities, violations of memory and neuralgia is possible. At young patients the neurologic symptomatology is usually poorly expressed and quickly disappears, at elderly serious violations up to paralyzes are sometimes observed.
At transdental dislocation of the Atlas (a fracture of tooth of an aksis and shift of an otlomk together with the Atlas of a kpereda) in the anamnesis the forced bending of the head or falling on the head is found. Patients with the rough shift of tooth and the Atlas die on the spot because of a medulla sdavleniye. In other cases the fixed position of the head and the pain in the top departments of a neck irradiating in a nape is observed. At the bursting Atlas's changes with the considerable shift of otlomk patients also perish on the place, in the absence of shift or small shift the feeling of instability of the head, pain or loss of sensitivity in a neck, parietal and occipital area is noted. Expressiveness of neurologic symptomatology can strongly vary.
At changes, perelomovyvikha, dislocations and incomplete dislocations of cervical vertebras there are pains and restriction of movements in a neck, expansion of an interspinal interval and local camber in the field of damage comes to light. The shtykoobrazny curvature of the line of awned shoots can be defined. More often nizhnesheyny vertebras suffer, in 30% of cases damage of a spinal cord is observed. In lumbar and chest department of a backbone the changes and perelomovyvikh which are followed by a breath delay at the time of a trauma, pain in the struck department, restriction of movements and tension of muscles of a back are usually diagnosed.
Symptoms of injury of a spinal cord are defined by the level and the nature of a trauma. Critical level – the IV cervical vertebra, at damage above this area arises the diaphragm paralysis involving respiratory standstill and the death of the victim. Motive violations are, as a rule, symmetric except for injuries of a horse tail and chipped wounds. Violations of all types of sensitivity are noted, both its decrease up to total disappearance, and a paresteziya is possible. Functions of pelvic bodies suffer. The blood-groove and a limfoottok is broken that promotes bystry formation of decubituses. At complete separations of a spinal cord the digestive tract ulceration which is complicated by massive bleeding is often observed.
Diagnostics and treatment of spine injuries
The diagnosis is exposed taking into account the anamnesis, a clinical picture, data of neurologic survey and tool researches. At damage of lumbar, chest and nizhnesheyny department appoint a backbone X-ray analysis in two projections. At a trauma of verkhnesheyny department (I and II vertebras) carry out a X-ray analysis through a mouth. Sometimes in addition do pictures in special laying. At suspicion on injury of a spinal cord carry out the spiral computer tomography ascending or the descending miyelografiya, a lyumbalny puncture with liquorodynamic tests, MRT of a backbone and a vertebralny angiography.
To patients with stable small damages appoint a bed rest, thermal procedures and massage. More severe injuries of a backbone are the indication for an immobilization (situation on a board, corsets, special collars), if necessary before an immobilization carry out reposition. Sometimes use skeletal extension. Urgent surgical interventions carry out at the accruing neurologic symptomatology (this symptom testifies to the proceeding sdavleniye of a spinal cord). Planned reconstructive backbone operations with restoration and fixing of the damaged segments carry out at inefficiency of conservative treatment.
Rehabilitation after uncomplicated spine injuries includes obligatory occupations of LFK. In the first days after receipt patients carry out breathing exercises, since second week – the movement by extremities. The set of exercises is gradually supplemented and complicated. Along with LFK apply thermal procedures and massage. At the complicated spine injuries appoint electropulse therapy, (nootropit) medicines for stimulation of metabolism, blood circulation improvement () and stimulations of regeneration (methyluracil). Use a vitreous body and fabric hormones.
The forecast depends on level and weight of damage, and also on a temporary interval from the moment of a trauma prior to full treatment. At slight stable spine injuries usually there comes the absolute recovery. At injury of a spinal cord there is a high probability of development of complications. Urological problems, hypostatic pneumonia and extensive decubituses with transition to sepsis are possible. The percent of an exit to disability is very high.