Ïîâðåæäåíèÿ ïîçâîíî÷íèêà, êîòîðûå íå ñîïðîâîæäàþòñÿ ïîâðåæäåíèÿìè ñïèííîãî ìîçãà è åãî êîðåøêîâ, íàçûâàþòñÿ íå-îñëîæíåííûìè. Â çàâèñèìîñòè îò àíàòîìè÷åñêîé ëîêàëèçàöèè ðàçëè÷àþò ïåðåëîìû òåë ïîçâîíêîâ, äóæåê, ñóñòàâíûõ, îñòèñòûõ è ïîïåðå÷íûõ îòðîñòêîâ.
Âûâèõè è ïåðåëîìû òåë ïîçâîíêîâ.Ïðè÷èíàìè ýòèõ ïîâðåæäåíèé ÿâëÿþòñÿ: ïàäåíèå ñ âûñîòû, òðàìâà ïðè àâòîìîáèëüíîé àâà-
ðèè, íåêîîðäèíèðîâàííîå ïàäåíèå íà òâåðäóþ ïîâåðõíîñòü â ðåçóëüòàòå ïîñêàëüçûâàíèÿ, ïðÿìîé óäàð â îáëàñòü ïîçâîíî÷íèêà. ×àùå ïîâðåæäàþòñÿ ïîçâîíêè â çîíå ïåðåõîäà îäíîé ôèçèîëîãè÷åñêîé êðèâèçíû â äðóãóþ, ò.å. íèæíèå øåéíûå è âåðõíèå ãðóäíûå, íèæíèå ãðóäíûå è âåðõíèå ïîÿñíè÷íûå.
Âûâèõ, êàê ïðàâèëî, âîçíèêàåò â øåéíîì îòäåëå, â ãðóäíîì è ïîÿñíè÷íîì îòäåëàõ ïðåîáëàäàþò ïåðåëîìû.
Ñòåïåíü êîìïðåññèè (êëèíîâèäíîñòü) ïîçâîíêà ìîæåò áûòü ëåãêîé, óìåðåííîé è ðåçêîé.
Ñèìïòîìû: ïðè ïåðåëîìå øåéíûõ ïîçâîíêîâ áîëüíûå æàëóþòñÿ íà áîëè ïðè ëþáûõ äâèæåíèÿõ øåè. Ïàëüïàöèÿ îñòèñòûõ îòðîñòêîâ è äèíàìè÷åñêàÿ íàãðóçêà ïî îñè âûçûâàþò áîëåçíåííîñòü íà óðîâíå ïåðåëîìà. Èíîãäà íàáëþäàþòñÿ êîðåøêîâûå ðàññòðîéñòâà â âèäå ãèïåðåñòåçèè.
Ïðè êîìïðåññèîííûõ ïåðåëîìàõ ãðóäíûõ è ïîÿñíè÷íûõ ïîçâîíêîâ äâèæåíèÿ òóëîâèùà áîëåçíåííû è îãðàíè÷åíû: áîëüíûå ñ òðóäîì ïîâîðà÷èâàþòñÿ íà æèâîò è èç ïîëîæåíèÿ ëåæà ïîäíèìàþò íîãè. Ìûøöû ñïèíû íàïðÿæåíû, íà óðîâíå ïåðåëîìà âûÿâëÿåòñÿ âûñòóïàíèå êçàäè îñòèñòîãî îòðîñòêà ïîâðåæäåííîãî ïîçâîíêà. Âîçìîæíû êîðåøêîâûå ðàññòðîéñòâà: ãèïåð- èëè ãèïîñòåçèÿ ñåãìåíòîâ, ðàñïîëîæåííûõ íèæå ïîâðåæäåííîãî ïîçâîíêà.
Äëÿ óòî÷íåíèÿ äèàãíîçà íåîáõîäèìà ðåíòãåíîãðàììà.
Ëå÷åíèå: ïðè ïåðåëîìàõ ãðóäíûõ è ïîÿñíè÷íûõ ïîçâîíêîâ ïðèìåíÿþòñÿ êàê êîíñåðâàòèâíûå, òàê è îïåðàòèâíûå ìåòîäû. Ñðåäè êîíñåðâàòèâíûõ ìåòîäîâ ëå÷åíèÿ íàèáîëüøåå ðàñïðîñòðàíåíèå ïîëó÷èëè ôóíêöèîíàëüíûé ìåòîä, îäíîìîìåíòíàÿ è ïîñòåïåííàÿ ðåïîçèöèÿ ñ ïîñëåäóþùèì ïîëîæåíèåì ãèïñîâîãî êîðñåòà.
Ôóíêöèîíàëüíûé ìåòîä ïîêàçàí ïðè íåáîëüøîé ñòåïåíè êîìïðåññèè (íå áîëåå õ /úâûñîòû òåëà ïîçâîíêà) è îòñóòñòâèè ñäàâëåíèÿ ñïèííîãî ìîçãà. Áîëüíîãî óêëàäûâàþò íà âîëîñÿíîé ìàòðàö, ïîëîæåííûé íà äåðåâÿííûé ùèò, ãîëîâíîé êîíåö êðîâàòè ïðèïîäíèìàþò íà 40 50 ñì. Ïðè ïåðåëîìàõ ãðóäíûõ è ïîÿñíè÷íûõ ïîçâîíêîâ âåðõíþþ ÷àñòü òóëîâèùà ôèêñèðóþò ëÿìêàìè, ïðîõîäÿùèìè ÷åðåç ïîäìûøå÷íûå âïàäèíû, ê ãîëîâíîìó êîíöó êðîâàòè (ðèñ. 16). Ïîä îáëàñòü ôèçèîëîãè÷åñêîãî ëîðäîçà ïîäêëàäûâàþò âàëèê, ÷òîáû îáåñïå÷èòü ìàêñèìàëüíóþ ðàçãðóçêó ïîçâîíî÷íèêà. Âàëèê äîëæåí áûòü òàêîé âûñîòû, ÷òîáû çàïîëíèòü èìåþùèéñÿ ëîðäîç. Ñ ïåðâûõ äíåé íàçíà÷àþòñÿ çàíÿòèÿ ËÔÊ, íàïðàâëåííûå íà ðàçâèòèå ìûøå÷íîãî êîðñåòà è ïðèîáðåòåíèå íàâûêà óäåðæèâàòü ïîçâîíî÷íèê â ìàêñèìàëüíî âûïðÿìëåííîì ïîëîæåíèè. Íàãðóçêà çàâèñèò îò ïåðèîäà ëå÷åíèÿ. Ïîñòåëüíûé ðåæèì ñîáëþäàþò 1,5 2 ìåñ. Òðóäîñïîñîáíîñòü âîññòàíàâëèâàåòñÿ ÷åðåç 4 6 ìåñ. Áîëüøèå ôèçè÷åñêèå íàãðóçêè èñêëþ÷åíû â òå÷åíèå ãîäà ïîñëå òðàâìû.
Îäíîìîìåíòíàÿ ðåïîçèöèÿ ñ ïîñëåäóþùèì íàëîæåíèåì ãèïñîâîãî êîðñåòà ïîêàçàíà ïðè çíà÷èòåëüíîé êëèíîâèäíîé
Ðèñ. 16. Âûòÿæåíèå íà äåðåâÿííîì ùèòå ïðè ïåðåëîìàõ ãðóäíûõ è ïîÿñíè÷íûõ ïîçâîíêîâ
êîìïðåññèè (îêîëî ! /2 âûñîòû òåëà ïîçâîíêà è áîëåå). Îñíîâíîé çàäà÷åé äàííîãî ìåòîäà ÿâëÿåòñÿ ðàñïðàâëåíèå ñëîìàííîãî ïîçâîíêà ôîðñèðîâàííûì ðàçãèáàíèåì ïîçâîíî÷íèêà ñ ïîñëåäóþùèì íàëîæåíèåì êîðñåòà äî êîíñîëèäàöèè ïåðåëîìà. Ðåïîçèöèÿ ïðîâîäèòñÿ íà óíèâåðñàëüíîì îðòîïåäè÷åñêîì ñòîëå. Ñðàçó æå íàêëàäûâàåòñÿ êîðñåò, ÷òîáû ïðåïÿòñòâîâàòü ñãèáàíèþ ïîçâîíî÷íèêà, íàõîäÿùåãîñÿ â ïîëîæåíèè ðàçãèáàíèÿ, â ñâÿçè ñ ýòèì êîðñåò è íàçûâàåòñÿ ýêñòåíçèîííûì. Çàòåì íàçíà÷àþò ËÔÊ, ìàññàæ, ñ 3-é íåäåëè ðàçðåøàåòñÿ õîäüáà. Ñíèìàþò êîðñåò ÷åðåç 4 6 ìåñ. Òðóäîñïîñîáíîñòü âîññòàíàâëèâàåòñÿ ÷åðåç ãîä.
Ïîñòåïåííàÿ ðåïîçèöèÿ îñóùåñòâëÿåòñÿ ïîñðåäñòâîì ïîýòàïíîãî óâåëè÷åíèÿ ðàçãèáàíèÿ ïîçâîíî÷íèêà â òå÷åíèå 1 2 íåä, êàæäûå 2 3 äíÿ óâåëè÷èâàÿ âûñîòó âàëèêà, ïîäëîæåííîãî ïîä ïîÿñíè÷íóþ îáëàñòü.
Îäíîâðåìåííî ñ ïîñòåïåííîé ðåïîçèöèåé ïðîâîäÿò çàíÿòèÿ ËÔÊ, ìàññàæ è ôèçèîòåðàïèþ. Íà 15 20-é äåíü íàêëàäûâàþò ýêñòåíçèîííûé êîðñåò.
Ïðè íåîáõîäèìîñòè îïåðàòèâíîãî ëå÷åíèÿ ðàñïðàâëåíèå ñëîìàííîãî ïîçâîíêà ïðîèçâîäÿò â ïðåäîïåðàöèîííîì ïåðèîäå ìåòîäîì îäíîìîìåíòíîé èëè ïîñòåïåííîé ðåïîçèöèè. Âî âðåìÿ îïåðàöèè ôèêñèðóþò îñòèñòûå îòðîñòêè ïîçâîíêîâ (ïî îäíîìó èëè ïî äâà) âûøå èëè íèæå ìåñòà ïîâðåæäåíèÿ.
Â ïîñëåîïåðàöèîííîì ïåðèîäå áîëüøîå çíà÷åíèå â ðåàáèëèòàöèè áîëüíûõ èìåþò çàíÿòèÿ ËÔÊ è ìàññàæ. ×åðåç 2 3 ìåñ ðåøàåòñÿ âîïðîñ î âîññòàíîâëåíèè òðóäîñïîñîáíîñòè.
Ïðè ïåðåëîìàõ è âûâèõàõ øåéíûõ ïîçâîíêîâ (èç-çà îïàñíîñòè ïîâðåæäåíèÿ ñïèííîãî ìîçãà) îäíîìîìåíòíàÿ ðó÷íàÿ ð å -
ïîçèöèÿ ïðèìåíÿåòñÿ î÷åíü ðåäêî. Íàèáîëüøåå ðàñïðîñòðàíåíèå ïîëó÷èë ì å ò î ä âûòÿæåíèÿ ïåòëåé Ãëèññîíà. Ïðè ïîâðåæäåíèè òðåõ âåðõíèõ øåéíûõ ïîçâîíêîâ ïðîâîäÿò ñêåëåòíîå âûòÿæåíèå (çà òåìåííûå áóãðû èëè ñêóëîâûå äóãè) íà íàêëîííîì ùèòå. Âàëèê ïîäêëàäûâàþò ïîä øåþ èëè ïîä ãîëîâó, â çàâèñèìîñòè îò íàëè÷èÿ ôëåêñîðíîãî (óãîë äåôîðìàöèè îòêðûò êïåðåäè) èëè ýêñòåíçèîííîãî (óãîë äåôîðìàöèè îòêðûò êçàäè) ïåðåëîìà.
Â äàëüíåéøåì (÷åðåç 5 7 äíåé) âûòÿæåíèå çàìåíÿþò ïîëóêîðñåòîì ñ îøåéíèêîì íà 2 3 ìåñ.
Ïðè ñòàáèëüíîì ïåðåëîìå øåéíûõ ïîçâîíêîâ ïðîâîäÿò ôóíêöèîíàëüíîå ëå÷åíèå: ËÔÊ, ôèçèîòåðàïèÿ, ìàññàæ.
Ïðè íàëè÷èè íåâðîëîãè÷åñêèõ ïîêàçàíèé, îñëîæíåíèé ïðèìåíÿþòñÿ îïåðàòèâíûå ìåòîäû ëå÷åíèÿ: äèñêýêòîìèÿ, ðåçåêöèÿ âûñòóïàþùåãî êçàäè ïîçâîíêà ñ çàìåíîé åãî êîñòíûì òðàíñïëàíòàíòîì.
Ïåðåëîì îñòèñòûõ îòðîñòêîâ ïîçâîíêîâ.Ïðè÷èíàìè ïåðåëîìà ÿâëÿþòñÿ ïðÿìîé óäàð ïî îáëàñòè îòðîñòêîâ èëè ïåðåðàçãèáàíèå è ðåçêîå ñãèáàíèå ïîçâîíî÷íèêà.
Ñèìïòîìû: ëîêàëüíàÿ áîëü â îáëàñòè ñëîìàííîãî îòðîñòêà, óñèëèâàþùàÿñÿ ïðè ñãèáàíèè è ðàçãèáàíèè ïîçâîíî÷íèêà, ïðèïóõëîñòü, ïðè ïàëüïàöèè ïîäâèæíîñòü îòëîìêîâ. Ðåíòãåíîãðàììà â áîêîâîé ïðîåêöèè óêàçûâàåò íà ëèíèþ ïåðåëîìà.
Ëå÷åíèå: îáåçáîëèâàíèå, ïîñòåëüíûé ðåæèì â òå÷åíèå 2 3 íåä. Òðóäîñïîñîáíîñòü âîññòàíàâëèâàåòñÿ ÷åðåç 3 5 íåä.
And about the frame (F5)
Spinal injury - a common injury, amounting to 2-12% of the total number of injuries of the musculoskeletal system. In young and middle age, men are more likely to suffer, in the elderly - women. In children, spinal injuries are detected less frequently than in adults. Usually, the cause is an intense traumatic impact, but in the elderly, spinal injuries can occur even with a minor injury (for example, during a normal fall at home or on the street).
The consequences depend on the characteristics of the spinal injury. A significant proportion of the damage is heavy lesions. According to statistics, about 50% of the total number of injuries ends with a disability. When the spinal cord is damaged, the prognosis is even more unfavorable - 80 to 95% of patients become disabled, and in about 30% of cases death is observed. Spinal injuries are treated by traumatologists, vertebrologists and neurosurgeons.
The spinal column consists of 31-34 vertebrae. At the same time, 24 vertebra are interconnected with the help of moving joints, while the rest fuse together and form two bones: the sacrum and tailbone. Each vertebra is formed by a massive body lying in front and an arch located behind it. The arches of the vertebrae are the receptacle for the spinal cord. Each vertebra, except for I and II cervical, has seven processes: one spinous, two transverse, two upper and two lower articular.
Elastic intervertebral discs are located between the vertebral bodies, and the upper and lower articular processes of the adjacent vertebrae are connected by joints. In addition, the vertebral column is strengthened by the ligaments: the posterior, anterior, supraspastic, interosseous, and interjust (yellow). This design provides the optimal combination of stability and mobility, and intervertebral discs absorb the load on the spine. I and II cervical vertebrae have the form of rings. The second vertebra is provided with a dentary process, a peculiar axis on which the head rotates with respect to the body along with the first vertebra.
Inside the vertebral arches is the spinal cord, covered with three shells: soft, hard and cobweb. In the upper lumbar spinal cord narrows and ends with a terminal thread, surrounded by a bundle of roots of spinal nerves (horse tail). The blood supply of the spinal cord is carried out by the anterior and two posterior spinal arteries. It has been established that the small branches of these arteries are unevenly distributed (some areas have a rich collateral network formed by several branches of the artery, others are supplied with blood from one branch), therefore, damage to some areas of the spinal cord can be caused not only by direct destructive effects, but also by impaired local blood circulation. due to rupture or compression of an artery of small diameter.
Causes of spinal injuries
In most cases, spinal injuries occur as a result of intense effects: road accidents, falls from a height, collapses (for example, building collapses during earthquakes, blockages in mines). The exception is the damage that appears against the background of previous pathological changes in the spine, for example, osteoporosis, primary tumor or metastasis. In such cases, spinal injury is often caused by a normal fall, blow, or even an awkward turn in bed.
As a rule, the type of spinal injury can be predicted by the nature of the impact. Thus, in road accidents, the driver and passengers often detect a whip injury - damage to the cervical spine caused by a sharp bending or extension of the neck during emergency braking or hitting the car from behind. In addition, the cervical spine suffers from a plunger's injury - jumping into the water upside down in an insufficiently deep place. When falling from a height, a concomitant injury is often observed: a fracture of the lower thoracic spine, a fracture of the pelvis and a fracture of the calcaneus.
Spinal injury classification
Depending on the presence or absence of injury, spinal injuries are divided into closed and open. Considering the level of damage, injuries of the lumbar, thoracic and cervical spine are isolated. Given the nature of the damage, there are:
- Spinal injuries.
- Distortion (tears or tears of articular bags and ligaments without displacement of the vertebrae).
- Fractures of the vertebral bodies.
- Fractures of the arches of the vertebrae.
- Fractures of the transverse processes.
- Fractures of the spinous processes.
- Vertebral fractures.
- Dislocations and subluxations of vertebrae.
- Traumatic spondylolisthesis (displacement of the overlying vertebra relative to the underlying ligament as a result of damage).
In addition, in clinical practice, there are stable and unstable spinal injuries. Stable injuries - those that do not pose a threat in terms of further exacerbation of traumatic deformity, with unstable injuries, deformation can be exacerbated. Unstable spinal injuries occur while the integrity of the posterior and anterior structures of the vertebrae is disturbed, and fractures, subluxations, sprains, and spondylolisthesis are among the injuries.
The division of spinal injuries in traumatology into two major groups is of major clinical importance: uncomplicated (without damage to the spinal cord) and complicated (with damage to the spinal cord). There are three types of spinal cord injury:
- Reversible (shaking).
- Irreversible (contusion, injury).
- Compression of the spinal cord (compression myelopathy) - arises due to edema, hematoma, pressure of damaged soft tissues or vertebral fragments, often formed under the influence of several factors at once.
Spinal injury symptoms
Spinal injury is manifested by diffuse soreness, subcutaneous hemorrhage, swelling and slight restriction of movement. A history of distortion usually reveals a sharp weight lifting. The patient complains of acute pain, movement is limited, pain is possible with palpation of the transverse and spinous processes, sometimes sciatica occurs. In case of fractures of the spinous processes, a history of a stroke or a sharp contraction of the muscles is noted, the victim complains of moderate pain, and the palpation of the broken process is sharply painful.
When fractures of the transverse processes occur spilled pain. A symptom of Payra (local pain in the paravertebral region, aggravated by turning the torso in the opposite direction) and a symptom of a stuck heel (inability to tear a straightened leg from the surface on the affected side while lying on the back). When whiplash injuries appear pain in the neck and head, possibly numbness of the limbs, impaired memory and neuralgia. In young patients, neurological symptoms are usually mild and quickly disappear, and in the elderly, serious disturbances, including paralysis, are sometimes observed.
In the case of transdental dislocation of the atlas (fracture of the axis tooth and displacement of the fragment together with the atlantus anteriorly), a forced bending of the head or falling onto the head is found in the history. Patients with a rough displacement of the tooth and the Atlanta die on site due to compression of the medulla. In other cases, there is a fixed position of the head and pain in the upper sections of the neck, radiating to the back of the head. With bursting Atlanta fractures with a significant displacement of fragments, patients also die on the spot, in the absence of displacement or slight displacement, there is a feeling of instability of the head, pain or loss of sensation in the neck, parietal and occipital region. The severity of neurological symptoms can vary greatly.
With fractures, fractures, dislocations and subluxations of the cervical vertebrae, pain and restriction of movements in the neck occur, a widening of the interspinal gap and a local bulge in the area of damage are detected. The bayonet-shaped curvature of the line of the spinous processes can be determined. The lower cervical vertebrae are more often affected; spinal cord lesion is observed in 30% of cases. In the lumbar and thoracic spine, fractures and fractures of the spine are usually diagnosed, accompanied by breath-holding at the time of the injury, pain in the affected part, restriction of movements, and tension in the back muscles.
Symptoms of spinal cord injury are determined by the level and nature of the injury. Critical level - IV cervical vertebra, if damaged above this area, paralysis of the diaphragm occurs, resulting in respiratory arrest and death of the victim. Movement disorders are usually symmetrical, with the exception of injuries of the horse's tail and stab wounds. Violations of all types of sensitivity are noted, perhaps as its reduction until the complete disappearance, and paresthesia. The functions of the pelvic organs suffer. Violation of blood flow and lymph flow, which contributes to the rapid formation of pressure sores. With complete ruptures of the spinal cord, ulceration of the gastrointestinal tract is often observed, which is complicated by massive bleeding.
Diagnosis and treatment of spinal injuries
Diagnosis expose taking into account the history, clinical presentation, data of neurological examination and instrumental studies. In case of damage to the lumbar, thoracic and lower cervical spine radiography is prescribed in two projections. In case of injury of the upper cervical spine (I and II vertebrae), x-rays are performed through the mouth. Sometimes they additionally take pictures in special styles. If spinal cord injury is suspected, spiral computed tomography, ascending or descending myelography, lumbar puncture with liquorodynamic tests, spinal MRI, and vertebral angiography are performed.
Patients with stable light injuries are prescribed bed rest, heat treatments, and massage. Heavier spinal injuries are indications for immobilization (position on the shield, corsets, special collars), if necessary, before the start of immobilization carry out reposition. Sometimes use skeletal traction. Urgent surgical interventions are carried out with increasing neurological symptoms (this symptom indicates continuing compression of the spinal cord). Planned reconstructive spinal surgery with the restoration and fixation of damaged segments is carried out with the ineffectiveness of conservative treatment.
Rehabilitation after uncomplicated spinal injuries includes compulsory exercises. In the first days after admission, patients perform breathing exercises, starting from the second week - movement of the limbs. Complex exercises gradually complement and complicate. Along with exercise therapy apply heat treatments and massage. With complicated spinal injuries, electropulse therapy is prescribed, drugs to stimulate metabolism (nootropil), improve blood circulation (cavinton) and stimulate regeneration (methyluracil). Use the vitreous and tissue hormones.
The prognosis depends on the level and severity of the damage, as well as on the time span from the moment of injury to the start of the full treatment. With mild, stable spinal injuries, complete recovery usually occurs. If the spinal cord is damaged, there is a high probability of complications. Urological problems, hypostatic pneumonia and extensive bedsores with the transition to sepsis are possible. A very high percentage of disability.
Causes of closed spinal injuries
To clarify the further presentation, we should recall the main ones (knowledge of how separate vertebrae are connected into a single organ - the spine. With the exception of the first two vertebrae - Atlanta and Aksis, the bodies of all underlying vertebrae are connected to each other using intervertebral disks - complex anatomical, formations, one of the functions of which is to keep the body of one vertebra relative to the body of another. Thus, the stability of the anterior spine is provided by the intervertebral discs or, more precisely, their fibrosis bubbled rings, as well as the front n to a lesser extent the posterior longitudinal ligament.
The posterior vertebrae are held relative to each other by the posterior-external intervertebral joints with their ligamentous and sumoral apparatus, interosseous, supraspastic, and yellow ligaments.
In general, the stability of the vertebrae is ensured by these four formations: the posterior-external intervertebral or, as they are also called, synovial joints, interspinal, yellow and posterior yellow ligaments, which we called the “posterior supporting complex” (“posterior ligamentous complex” according to Holdsworth). In all those cases when the elements of the “posterior support complex” remain intact, the damage to the spine remains stable. In all those cases when the “rear support complex” is damaged, the spinal injuries are unstable.
Flexion mechanism. Flexion violence affecting the spine occurs when there is a sudden, significant, momentary, forced flexion of the human body. Such a mechanism of violence arises when the weight of the victim falls upon the victim, when the buttocks or straightened yogis fall from the height of pa. Breaking force is expended on overcoming the resistance of the extensor muscles and on the fracture of the vertebral body and is extinguished by this fracture. As a rule, with such a mechanism of violence, the anatomical structures of the “rear support complex” are not damaged. There is a typical compression wedge-shaped perolom of the vertebral body, a fracture characteristic of the lumbar and lower thoracic localization. Since the structures of the “posterior support complex” are not damaged, this type of spinal injury should be classified as stable.
In some rare cases, when, after the vertebral body fracture, the damaging violence continues to operate and increases its magnitude, the ligaments of the “rear support complex” may break. Then unstable damage may occur.
In the cervical spine, where the anatomical structures of the “posterior support complex” are less strong, flexion violence may cause flexion sprains or fracture sprains, which are unstable injuries.
Extensor mechanism. Until recent years, it was believed that extensor damage to the spine is extremely rare. Indeed, such a mechanism of damage is rarely the cause of damage to the thoracic and lumbar spine. However, it occurs frequently in the cervical region. Approximately about half of the damage to the cervical spine occurs due to extensor violence.
Extensive violence occurs when a sudden one-stage hyperextension of the spine. With such a mechanism of violence, the anatomical structures of the “rear support complex” remain intact. There is either a fracture in the roots of the arches, or, which is more often observed in the cervical spine. rupture of the anterior longitudinal ligament and intervertebral disk or spongy substance of the vertebral body near the endplate, and there is an extensor dislocation. This damage is stable provided that the flexion position is maintained. If such an injured person is treated with hypertension, then he can be irreparably damaged.Extensive damage to the cervical spine often occurs in motorists and divers when the head was in the extension position when it hit the river bottom.
Flexion-rotation mechanism. When exposed to flexion-rotational violence or purely rotational, as a rule, damage occurs to the anatomical structures of the “rear support complex”. If only the ligaments are damaged, which is more often observed in the cervical region, a pure dislocation occurs: if the articular processes and the anterior sections of the spine break simultaneously, a fracture-dislocation occurs. Both sprains and porous dislocations are classified as unstable injuries. Pure dislocations most often occur in the cervical spine, much less often in the lumbar spine and never occur in the thoracic, which has an additional rigid attachment in the form of the chest.
A classic place for the occurrence of fractures and dislocations are the lumbar and lumbar-thoracic spine. Not rarely, they are found in the cervical region and only rarely in the thoracic. Flexion-rotational violence occurs when gravity falls on the region of one shoulder girdle or shoulder blade, when it acts not symmetrically and not only flexes, but also rotates the spine around its vertical axis. This mechanism of violence often occurs in rail and road accidents. Very often, these fractures are combined with damage to the contents of the spinal canal.
Compression mechanism. The compression mechanism of violence lies in the fact that the breaking force acts on a sheer vertical, attached to the vertebral bodies. Such a mechanism of violence is characteristic only of the cervical and lumbar spine, the bodies of which in a certain position can be located strictly in a vertical line. The normal position for the cervical and lumbar spine is physiological lordosis. In the position of slight bending, the cervical or lumbar spine is straightened, lordosis is eliminated, and the vertebral bodies are located along a plumb line. When at this moment violence occurs on the vertebral bodies vertically, a comminuted fracture fracture of the vertebral body occurs. With such damage, the “rear support complex” structure remains intact, why this type of damage is classified as stable.
The mechanism of this fracture was studied in detail and described by Roaf in 1960. At the same time, severe damage to the spinal cord and its elements often occurs with a posterior fragment of the body of a broken vertebra moving toward the spinal canal.
These are the four main mechanisms of spinal injury, which determine the nature of each spinal injury.
Symptoms of closed spinal injury
Symptoms of spinal injury should reflect the degree of stability of the existing damage, the presence or absence of complications from the spinal cord or its elements, and the specific clinical form of spinal injury. A detailed clinical diagnosis can be made on the basis of a detailed clarification of the circumstances of the injury and the material cause that caused it, clarification of the place of its application and the nature of the possible impact, objective examination and examination data and, finally, high-quality spondlograms in at least two projections - anterior and lateral.
However, when providing first aid to an injured person at the scene of an accident, it is important to know at least approximately whether there is a stable or non-stable damage. This is important to know because the transportation of an injured person with unstable damage is more responsible and requires taking measures to exclude the possibility of additional or secondary damage to the contents of the spinal canal. The doctor may suspect unstable damage on the basis of anamnesis and examination of the victim. The presence of swelling, bruises in the form of abrasions and bruises in the interscapular region allows you to think about a purely bending mechanism, the presence of bruises and abrasions in the region of a single shoulder strap or shoulder blade - a flexion-rotational spacing, etc. and interspinal ligaments. The increase in the interspinous gap and the brokenness of the lines of the spinous processes in the form of a bayonet makes it possible to consider as reliable the suspicion of the presence of unstable damage. The fall of gravity on a slightly bent head allows you to think about a comminuted fracture fracture of the body of the cervical vertebra, bruises and abrasions in the nape of the diver's head - about flexion damage, about the forehead and face - about the extensor.
The final clinical diagnosis is formulated after a detailed examination of the victim and is an effective starting point for choosing the most rational and expedient method of treatment.
Treatment of closed spinal injury
Surgery on the spine with its injuries and their consequences have a number of specific features. These features are generated by the peculiarity of the spinal column as an organ and the multifaceted and responsible role that it plays in human life, as well as its location in the human body. All this makes it necessary for the physician who decides to undergo surgery on the cervical, thoracic or lumbar spine to know perfectly well the normal and pathological anatomy of the spine, the topographic-anatomical relationship of the spine with its surrounding formations, to be able to navigate them. When invading the spinal cord, the surgeon must be prepared to eliminate possible complications due to damage to the paravertebral formations that have previously occurred or occur during the operation.
Located at a considerable distance in the human body. the spine is intimately in contact with the median formations of the neck, the posterior mediastinum and retroperitoneal space, the organs of the chest and abdomen. When using the front operative accesses to the spine, the surgeon inevitably comes into contact with all the above-mentioned: formations that may be damaged during surgery. All this requires that the doctor, operating on the spine, have perfect mastery of the surgery of the thoracic and abdominal cavities, surgery of the neck organs, vascular surgery, and elements of neurosurgery.
Many spinal surgeries can be performed only under endotracheal anesthesia. A well-established anesthesia service is a prerequisite for surgical interventions on the damaged spine. No less important and prerequisite is the opportunity to proceed with immediate intensive care and resuscitation in case of severe shock or blood loss. Timely and complete replacement of blood loss during the operation requires an adequate supply of preserved blood. Finally, surgery on the damaged spine requires special equipment and equipment.
Indications and contraindications. The use of surgical methods of treatment is shown in the following cases.
- Damage to the cervical spine:
- a) all unstable injuries (dislocations, fractures of dislocations), especially if they are combined with damage to the contents of the spinal canal. With these injuries, we consider surgical treatment methods to be less dangerous for the victim. They allow you to create a reliable internal immobilization in the place of the former damage and transfer the unstable damage to stable, prevent the subsequent occurrence and development of degenerative processes in the intervertebral discs at the level of the former damage and in this sense are not only purely medical, but also therapeutic and prophylactic, greatly facilitate care for the sick and make it mobile. When they reduce the duration of stay of the victim in bed and in the hospital,
- compression comminuted fractures of the bodies of the cervical vertebrae,
- all types of damage to the cervical spine, in which conservative methods and methods are untenable and they can not achieve the desired effect.
- Damage to the thoracic and lumbar spine:
- compression wedge-shaped uncomplicated fractures of the bodies of the lumbar and lower thoracic vertebrae,
- comminuted compression fractures of the bodies of the lumbar vertebrae,
- fracture-dislocations of the lumbar and thoracic spine.
Contraindications: lack of necessary qualifications and sufficient experience of the surgeon, the necessary equipment, equipment and a well-established anesthesiological service, the serious condition of the injured due to spinal injury or associated severe injuries, precluding the possibility of surgical intervention, the presence of diseases that preclude the possibility of surgical intervention, the elderly biologically elderly age .
Anesthesia. When choosing a method of anesthesia, one should be guided by the following two main points - the safety of the method of anesthesia for the victim and the convenience for the operating surgeon. With regard to spinal surgery, these two requirements are best met by endotracheal anesthesia.
A modern tracheal anesthesia performed by a qualified, experienced anesthesiologist seems to be the safest for the victim. This type of anesthesia creates maximum comfort for the surgeon. Relaxation of the muscles and the shutdown of spontaneous breathing provide considerable convenience for interventions performed on the lumbar spine using extraperitoneal surgical approaches. Controlled breathing negates the dangers associated with accidental wounding of the pleura during extrapleural access to the bodies of the thoracic vertebrae, with injury of the mediastinal or parietal pleura of the opposite side when using transpleural operative access. The wide opening of the pleural cavity, manipulation in the posterior mediastinum, near the pericardium and the roots of the lungs, the aortic arch and the large blood vessels extending from it inevitably lead to impaired external respiration and hemodynamics, in particular central venous pressure. Thoracotomy, produced in controlled breathing, can largely compensate for the negative effects of pneumothorax. The role of this type of anesthesia during surgery on the cervical spine is invaluable. The possibility at any time, if necessary, to switch to long-term controlled breathing in case of injuries or surgical interventions on the cervical spine allows you to confidently perform the necessary manipulations on both the anterior and posterior sections of the cervical vertebrae, the lower, middle and especially the upper segments of the cervical spine.
Reanimation. Surgical interventions in the anterior parts of the damaged spine are in inevitable contact with large main blood vessels. In the case of injury of these large, especially venous, vessels, simultaneous massive bleeding may occur, leading to severe collapse and even clinical death. The life of the victim in these cases depends on the speed and usefulness of the manipulations carried out to revitalize the victim. Therefore, spinal surgery should be arranged so that all the necessary activities for the revitalization can be started instantly. In addition to special equipment for resuscitation (sets for intra-arterial blood transfusion, a set for a tracheostomy, an apparatus for automatic breathing, a defibrillator, etc.) and a set of necessary medications. To help the anesthesiologist, a special doctor is allocated who is familiar with all the revitalization manipulations and is ready to begin their implementation instantly. In advance, before the operation, you should prepare the most accessible for quick exposure venous and arterial trunks, so as not to lose precious minutes to search for them at the moment of need.
The use of posterior operative accesses in a number of surgical interventions on the spine is not associated with the need for direct contact with large arterial and venous trunks. Despite this, the blood loss during these surgical interventions is incomparably greater than with the use of technically correctly performed front surgical approaches. Therefore, during surgical interventions on the posterior spine, it is necessary to carefully monitor the amount of blood lost and promptly compensate for blood loss.
As a rule, with the front approaches, the outcrop of the spine produces no blood loss and only manipulations on the vertebrae lead to it. The magnitude of blood loss in these cases is directly proportional to the volume of manipulations on the spine — the wider the spongiosis is exposed, the more vertebral bodies are deprived of compact bone, the more significant the blood loss is. Blood loss is especially increased during manipulations near the roots of the arches and intervertebral holes. Blood loss may be significant during surgery for chronic spinal injury. During surgical interventions on the bodies of the children's vertebrae, significant bleeding may occur from the bas-vertebral vessels.
Preparing the victim for surgery depends on the nature of the damage, its location, the urgency of the intervention, the condition of the victim, the presence or absence of associated injuries and the disease.
Online access. The success of surgery depends largely on the rational access to the object of intervention. Existing operational access to the elements of the vertebrae can be mainly divided into anterior and posterior ones. Rear operative accesses are most common in surgical interventions for various spinal injuries. Without denying the value and benefits of these accesses for certain interventions on the posterior spinal cord, we emphasize that these accesses do not justify themselves in a number of surgical interventions on the damaged spine. At the same time, the anterior ones - direct access to the vertebral bodies and intervertebral discs, which are most often exposed to damage, are far from being sufficiently used in spinal cord injury surgery. There is a misconception that the anterior accesses to the spine are too heavy and risky for the injured, they are sometimes aggravated by an already serious condition. The magnitude of the blood loss and the severity of the condition operated on through the posterior operative accesses are incomparably large, the postoperative period is more difficult and difficult and is fraught with less and more complications.
The main advantages of the front operative accesses, if there are appropriate indications, are that they provide: wide access to the anterior parts of the damaged spine, the possibility of expanding this access in the process of the intervention, if necessary, the ability to visually monitor the manipulation of the spine, multiple vertebral injuries, the possibility of simultaneous intervention in some types of combined damage Nij, minimal risk of damage to paravertebral anatomical structures and elimination of complications if they occur, the lack of direct contact with the spinal cord and its membranes, spinal nerve roots, ganglia, and so on. n., rear safety is not damaged spine.
All the listed benefits are extremely important.
Manipulations on the damaged spine. The nature of the manipulations performed on the damaged part of the spine depends in each individual case on the clinical form of the existing damage, the presence or absence of complications from the contents of the spinal canal, the condition of the affected person and the goals and objectives that must be achieved by this intervention. Some points should be emphasized.
- With unstable injuries, various types of bone grafting on both the anterior and the posterior posterior segments of the damaged spine do not create an early primary stability of the damaged segment of the spine. In these cases, stability occurs only after the onset of the bone block, after a time that is necessary for the implantation and restructuring of bone grafts.
- Early primary stability of the damaged segment of the spine can be achieved only by fixing the damaged segment of the spine with hard metal clamps.
- Usually, various metal or other rigid fixators prove to be consistent for a certain period, after which they lose their useful function. This period of the consistency of metal structures should be reasonably used to obtain permanent stability with the help of osteoplastic fixation.
- The most expedient implementation of simultaneous stabilization with the help of metal structures and bone plastics, if there are corresponding indications. In these cases, the early stabilization will be provided by metal structures, and the final - by the bone block that has emerged during this time.
- If it is impossible to simultaneously stabilize the damaged segment of the spine with metal structures and osteoplastic fixation, if there are appropriate indications of spinal fusion with bone grafts, the second stage should be carried out before the victim is lifted upright.
- With stable lesions, the use of metal fixers and various types of bone grafting is consistent.
- More perfect and harmonious "implantation" of autografton inserts give preference to autocapacity. Homology can only be used for compelled indications.
Spinal and spinal cord injuries account for 12% of injuries of the musculoskeletal system. In childhood, such disorders are extremely rare. In an adult, injury occurs only with severe bruises. Older people just stumble and fall to get serious damage.
The consequences of injury to the cervical spine and other segments depend on the degree of damage. Severe injuries are most often observed: in 50% of cases, a person after a violation has been registered forms a disability. Spinal cord lesion has an unfavorable prognosis - about 95% of victims become disabled. Mortality is up to 30% of cases. For treatment, refer to a neurosurgeon, spine or trauma surgeon.
Causes of spinal injuries are associated with various factors. Among the most frequent should be highlighted:
- Car accidents. It is mainly about whiplash injuries that occur during sharp bends and tilting of the head, which causes damage to the ridge.
- Fall from a great height. The causes of this kind are the most dangerous, because they are accompanied by fractures and disorders of the spinal cord. Worst of all, if the victim during a fall lands on the lower limbs. Such a bruise most often leads to damage to the spine, which is accompanied by a violation of blood circulation.
- Trauma "diver". In the summer, a large number of people injured while swimming in the reservoirs enter traumatology. This happens when diving from a great height, when there are obstacles on the way or the depth is insufficient. At the same time, there is a strong flexion of the cervical spine, which is fraught with serious injury to its segments.
The cause of violations of the body of the vertebrae can be gunshot or knife wounds. Breaks and sprains appear at birth trauma.
Anatomical structure of the spine
The structure and projection of the human spine
The spine is one of the most complex structures of the musculoskeletal system. The anatomy of the spine is caused not only by the need to make the human body as mobile as possible, but also by the fact that this bone-cartilage structure must ensure the protection and functioning of the spinal cord, through which nerve signals from the brain to all tissues and organs of the body are conducted.
The spine is a multi-segment and rather strong structure, which includes from 31 to 34 vertebrae. Separate vertebrae fused together, which reduced the mobility of individual areas, an example of such accretebral vertebrae is the tailbone and the rudimentary tail of a person. All other vertebrae have a free connection due to cartilage structures, which allows them to move more freely.
Formally, the spine can be divided into 3 main sections.
It is the moving parts of the spine that are most susceptible to various kinds of damage in the event of mechanical impact. Special attention should be paid to the elements connecting the bone vertebrae, that is, the intervertebral discs.
Intervertebral discs are durable fibrous capsules, which not only help to increase the mobility of the bone vertebrae, but also perform a shock-absorbing function, thereby preserving the bone structures during shakes and excessive loads. In addition, intervertebral discs are a necessary binding element to maintain the integrity of the spinal column.
Inside the spinal canal is the spinal cord, which on the one hand is connected to the brain, and on the other - has a lot of nerve processes that transmit signals to all tissues of the body.
In addition, large blood arteries run near the bone and cartilage structure of the spinal column, in case of violation of which serious consequences can be observed due to spinal injuries.
Prevalence and root causes of damage
Spinal injuries account for about 12% of cases of damage to elements of the musculoskeletal system. Men under the age of 45 are more likely than women to be prone to spinal injury, while injuries to this area in older people occur at an equal percentage for both sexes. In children, serious spinal injuries are rarely encountered, which is connected not only with the fact that at this age the bone and cartilage structures have a more elastic structure, which makes the child much easier to survive possible injuries, but also with the fact that children, as a rule, less likely to be in traumatic situations. It is worth noting that most cases of spinal injury are associated with the following events:
- traffic accidents
- falls from a great height
- diving attempts in water bodies with shallow depth,
- collapse of significant severity per person.
In the situations presented above, severe vertebral injuries and damage to the spinal cord are most often observed, but there are other causes and factors that can lead to the complete or partial destruction of individual vertebral structures.
Often a sharp increase in considerable weight results in damage to the lumbar spine. In this case, compressional injury may also occur, which is accompanied by a significant pain syndrome due to the infringement of the nerve root that leaves the spinal cord.
With sharp bending of the neck, whiplash injuries often occur, in which there is a shift in the structures of the cervical spine. Spinal injury in older people is usually observed against the background of an existing degenerative-dystrophic disease, since the presence of bone-cartilage structures that are weakened due to the disease increases the risk of serious spinal and spinal cord injuries. In newborns, spinal injury is often the result of a birth injury.
It is worth noting that the degree of damage to the spine may depend on additional factors. For example, women suffer more often than men in automobile accidents the cervical region, which is due to the fact that in women in this area the muscles are less developed.
Muscles are an important supporting component for the entire spine, therefore, for people with poorly developed or atrophied muscle carcases, back injuries and spinal cord injuries in adverse situations are more serious than those who play sports and have developed muscles.
Symptoms and signs of illness
Different degrees of damage to the vertebrae
Manifestations of spinal injury can have different degrees of intensity, depending on the characteristics of the existing damage. Many people who suffer from a spinal injury are seriously shocked. Being in a state of shock, a person may not feel pain and try to change the position of the body, which can lead to even greater complications.
Characteristic signs of injury can occur either immediately or after a while. In the area of injury localization, pain sensations of varying degrees of intensity may occur. Sometimes pain can spread to the lower or upper limbs.
Signs of damage to the vertebrae can be manifested in limiting the sensitivity or motor ability of the limbs. Depending on the degree of damage, there may be signs and symptoms inherent in such a disease as sciatica. Often, victims complain of headaches, memory problems, neuralgia, etc.
Separately it is necessary to highlight signs of damage to the spinal cord. The most common manifestations of spinal cord injury include the following symptoms:
- numbness in different parts of the body of varying severity,
- leg paralysis,
- paralysis of all limbs
- tingling in limbs
- rapid breathing
- rapid pulse,
- strong anxiety
- excited state
- loss of consciousness,
When spinal cord ruptures due to spinal injury can be signs of a violation of the internal organs. Each specific case of spinal injury has its own characteristics, which is why each case requires the selection of individual therapy and rehabilitation methods.
How is the treatment carried out?
Treatment of spinal injuries is a big deal. With stable lesions, both conservative treatment methods and surgery can be used, which involves the installation of metal plates to restore or strengthen the spinal column, although this reduces the mobility of the spine. With unstable injuries, surgery is the only way to prevent the problem from getting worse.
In addition, surgery is the only method of exposure when it is necessary to restore blood supply or to eliminate the elements that pinch the spinal cord. Conservative treatment methods are effective only with stable injuries, when such manipulations can be performed without harming the spine. Such methods include anti-inflammatory and painkillers, massage, heat treatments and temporary spinal immobilization.
In about 5% of cases of complicated spinal injuries, patients die either instantly or within a few weeks. In another 65% of cases of complicated injuries, the consequences become irreversible. The process of treatment and rehabilitation of spinal cord injury in these cases can take quite a long time, and sometimes the whole life.
In complex cases of spinal cord injury, the patient requires comprehensive assistance from a surgeon, a neurosurgeon, a traumatologist and a rehabilitologist. Prevention of such damage is to avoid traumatic situations.
Causes, symptoms and treatment of uncomplicated spinal injuries
Doctors often have to assist patients with spinal cord injury. As practice shows, many have uncomplicated spinal injuries, which are mainly the result of domestic or sports injuries.
Much less often violation is provoked by the development of osteoporosis. In the case of an uncomplicated form of injury, physicians resort to conservative treatment.
Varieties of injury
To effectively determine the method of treatment in traumatology, it is customary to classify back injuries for complicated and uncomplicated injuries of the spine.
If the spinal cord was damaged during a fracture, a complicated form is diagnosed. Uncomplicated call such damage to the spine, in which:
- no vertebral shift,
- the spinal cord and its shell are preserved whole
- the front longitudinal ligament of the spine remains intact.
Among the listed types of injuries distinguish damages:
The most common is a compression fracture, the essence of which lies in the injury of vertebral bodies, accompanied by a decrease in their height.
Also, injuries are closed and open. They are diagnosed by the presence or absence of damage to soft tissue and the surface of the skin. The most common type of injury.
A fracture of the last two thoracic vertebrae and the L1 vertebra usually occurs, but localization of injuries in other places is not excluded. Those who prefer sports and car racing mainly deal with the deformation of the cervical vertebrae.
Complicated and uncomplicated spinal fractures are caused by a number of reasons. A person may suffer as a result of:
- playing sports
- traffic accident,
- falls from a great height
- lifting too heavy objects
- unsuccessful body rotation,
- development of osteoporosis,
- the formation of tumors in the spinal column.
Uncomplicated compression fracture of the spine often occurs at a time when a person, falling from a height, lands on straight and tense legs or on the buttocks. Many children go to the hospital with a similar diagnosis because of their increased activity.
If we consider an absolutely healthy spine, then it is able to cope with a significant load and can suppress the impulses that appear during the impact.
With age, the risk of compression fractures increases, as changes in the body or existing diseases lead to weakening of the bone tissue.
According to statistics, uncomplicated compression damage to the spine in patients over 50 are due to osteoporosis.
Doctors are constantly reminded of timely diagnosis. Patients make a huge mistake when they postpone a visit to the doctors after injury, hoping that the pain will pass on its own.
Signs of uncomplicated compression damage at the initial stage are characterized by weak severity. Without noticing any particular changes in the behavior of the affected child, parents often do not rush to seek help, and the violation is compounded.
Fracture due to injury causes severe pain. If the vertebra collapses slowly, pain does not appear immediately. Usually they declare themselves after exercise.
Uncomplicated damage is accompanied by:
- a sharp pain in the place where the vertebra was damaged, although discomfort sometimes appears in the abdomen,
- the increase in pain in the process of walking or in a standing position, as well as its decrease when a person lies down,
- the inability to properly turn or lean,
- breathing problems
- swelling of tissues in the affected area.
In the lumbar region, compression fractures are often diagnosed, since the lumbar vertebrae have the greatest load. As a result of injury to this area, in addition to acute pain, the victim will deal with:
- growing weakness
- numbness of the back and limbs
- intestinal obstruction
- traumatic shock (in rare cases).
The sensations are localized depending on which vertebra is damaged. L1 vertebrae fracture occurs most often, because it is he who takes the load. If there are no complications, the patient has all chances to fully recover.
Much less common is an uncomplicated closed compression fracture of the body of the L3 vertebra, because its location plays a big role in this. Trauma in a given area usually happens due to a direct blow.
When a person falls on the buttocks, vertebra injury L5 is not excluded. Localization of pain occurs in the lumbar region, but often it gives to the groin area.
Features of the therapeutic course
Patients with uncomplicated injuries prescribed conservative treatment, the essence of which consists in the use of:
- pain medication (only prescribed by a doctor),
- fixing devices
- special mode.
Initially, the patient should be in a supine position on a solid foundation.
How long does an uncomplicated spinal fracture heal? A patient for 12-14 weeks is forbidden to lift heavy objects, sit down, do bends and turn sharply. If necessary, a plaster corset is applied for six months.
The treatment can not do without physical therapy, as well as the injured place grows together much better and faster. Exercise therapy is prescribed 1.5-2 months after the injury occurred. Classes are carried out under medical supervision.
Thanks to the use of an orthopedic corset, an extra load is removed from the spine, which speeds up recovery.
If the patient listens to the recommendations of physicians and does not violate them, the damaged area will overgrow in about 3 months.
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Denial of responsibility
The information in the articles is intended solely for general information and should not be used for self-diagnosis of health problems or for medical purposes. This article is not a substitute for medical advice from a doctor (neurologist, therapist). Please consult your doctor first to know exactly the cause of your health problem.
ICD injury code 10
According to ICD 10, a spinal injury, namely a fracture, is encrypted with T08. Spinal cord injuries receive cipher T09.3. The effects of damage to the neck and trunk are separately encoded. So, the consequences of a back injury are given the code for ICD 10 - T91.1.
All injuries of the back can be divided into traumatic and pathological. Traumatic occur due to the application of force of great intensity. Pathological are the result of diseases of the musculoskeletal system. Causes of domestic spinal injuries are falling, the breaking of heavy objects. Injury common in the sports environment. Injury can be obtained when doing gymnastics, skiing, ski jumping. In children, spinal injuries are the result of careless games, neglect of safety rules.
In newborns, spinal injury occurs during childbirth. Improper presentation of the fetus, rapid delivery and errors of obstetricians during childbirth lead to damage to the predominantly cervical spinal structures. Multiple births are especially hard. Caesarean section is designed to minimize the risk of unpleasant consequences.
Common causes of severe spinal injuries are car accidents. People get into traffic accidents every day, which leads to combined violations and unspecified injuries. One of the most frequent phenomena is whiplash damage - with a sharp bending and extension of the neck. This happens when a car with passengers suddenly slows down. Head and spinal injuries also occur due to natural disasters and industrial accidents.
Symptoms depend on the level of damage to the structures. Bruises and minor injuries of the thoracic spine have minor manifestations. There is spilled pain, movement is slightly limited, hematomas appear. Signs of trauma to the ligaments without displacement of the vertebrae are:
- pain with palpation,
- symptoms of sciatica,
- significant limitation of mobility.
Symptoms of a spinal cord injury such as a fracture are more pronounced. A person cannot lift a straightened leg from the floor, suffers from pain, is not able to turn the torso. Injuries to the head and upper spine are accompanied by a decrease in sensitivity below the level of damage and numbness of the extremities. Elderly people experience paralysis, while young patients quickly resolve neurological symptoms.
Additional symptoms of wounds of the cervical spine are headaches, memory impairment. Due to the strong displacement of human vertebrae paralyzing, Atlanta fractures can cause instant death.
Due to the trauma of the spinal column and spinal cord, urinary incontinence develops. When fractures of the spinous processes occurs muscle spasm. Damage above the 4th cervical vertebra leads to impaired breathing and changes in blood flow. Compression of the medulla oblongata, as well as complete damage to the spinal cord, leads to death at the scene.
First aid is to ensure the safety and immobility of the victim. In spinal cord injuries, there is a high likelihood of concomitant complications; therefore, physical activity is minimized. Transportation of the victim with a spinal injury is carried out on a hard stretcher. Immobilization is carried out with orthopedic structures or improvised means — sand bags, rollers rolled out of fabric, etc. The victim must be lying during transport. It is better if the ambulance team takes care of the transportation.
First aid for injuries involves the following actions:
- conduct anti-shock therapy - eliminate bleeding, restore breathing,
- sanitize wounds whenever possible
- in case of damage to the lower parts, it is possible to take painkillers - analgesics,
- bleeding wounds are closed with pressure bandages.
What to do if the victim is unconscious? First aid for spinal injury involves the cleansing of the nasal passages and oral cavity from vomitus. If attempts to bring a person to life are unsuccessful, they monitor the breathing and heartbeat until the ambulance arrives.
Emergency care provided by physicians on site involves measuring blood pressure and pulse, recording an electrocardiogram. In the framework of first aid for spinal injuries, an immobilization bandage or a corset is applied. In the absence of respiration, heart massage and artificial lung ventilation are performed. Similarly, there is first aid for spinal injuries in childhood. Further manipulations are carried out in the clinic after transportation.
As a result of the rupture of soft tissues, neurological symptoms increase. In this case, urgent surgery is recommended. Its task is to eliminate the compression of the spinal cord. Also, operations are performed if conservative therapy for spinal injury does not give a positive effect. Segments are restored and fixed with metal structures. Stabilizing operations for spinal cord injuries preclude re-compression.
The necessary conditions for successful recovery from an uncomplicated spinal injury are moderate physical activity, proper nutrition, and patience. Get recommendations for recovery from spinal injuries can be in medical rehabilitation centers. The methods of physiotherapy will allow the vertebrae to recover - electropulse therapy, acupuncture, thermal procedures, balneotherapy. In this case, it will be possible to return to normal life for 1-6 months.
Rehabilitation centers offer patients a gentle massage of the spine, exercise therapy, kinesitherapy. After a complicated injury, rehabilitation takes 1.5 years. The patient requires professional and social adaptation, perhaps the development of a new profession.
Exercise therapy for mild spinal injury is appointed in the first days after surgery or removal of contraindications. In the initial period, axial loads are excluded, the emphasis is placed on bracing exercises and therapeutic gymnastics, which improves blood circulation. Physical culture is carried out 2-3 times a day for 10 minutes.
The complex exercise exercise in spinal injuries includes:
- Stage 1, 2 weeks - breathing exercises, movements with legs from a prone position, raising the pelvis,
- Stage 2, 3-4 weeks - flexion and extensor exercises from lying on the back and abdomen, waving your arms, “bicycle”,
- Stage 3, 4-6 weeks - transition to axial loadings, occupations with the minimum burdening.
At the same time, physiotherapy is prescribed, which increases the effectiveness of physical therapy in spinal injuries. Physiotherapy procedures are prescribed for 10-12 days. Swimming will be especially useful for back problems. It is worth visiting the pool for both children and adults who are traumatized if there are no contraindications.
Complications and consequences
Negative effects occur with injuries of the spinal cord and cervical spine. If a person develops paralysis, there are associated disorders: deep bedsores, pneumonia and pneumonia, and pathologies in the urogenital area. Many of the complications of vertebral disorders lead to disability. The most common consequences of injuries to various parts of the spine are:
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- chronic dorsalgia
- instability of the vertebrae
- osteochondrosis and sciatica,
- neurological disorders with characteristic symptoms - numbness, tingling, etc.,
- paralysis of limbs
- spinal canal stenosis,
- kyphotic curvature,
- dysfunction of the pelvic organs.
The prevention of possible spinal injuries is usually thought to by those who have already had back problems. The risk of injury increases with age, due to the weakening of the ODE. Recommended correction power. Cottage cheese, kefir, ryazhenka, sesame and other foods with a high content of calcium are introduced into the diet.
Prevent injuries of the spine, shoulders and head are capable of protective equipment, which is necessary for athletes, people working in hazardous industries, etc. You should not take high loads when doing physical work. With extreme caution, take the weight in case of previous injury or long physical passivity. In order to prevent accidents in sports activities, the observance of safety rules is crucial.
Dear readers of the site 1MedHelp, if you still have questions on this topic, we will be happy to answer them. Leave your feedback, comments, share stories of how you have experienced a similar trauma and successfully coped with the consequences! Your life experience can be useful to other readers.
Bruises and torn ligaments (distortion)
The easiest type of disorders in the field of muscle and joint structures. Most often localized in the lumbar spine and tailbone. For severe bruises, a fracture is possible that requires long-term treatment. The lightest lesions are not accompanied by complications.
Distortion is characterized by tearing or tearing without subsequent displacement of the segments. In case of injury of the thoracic spine, there is a limitation of motor activity. In this case, the danger lies in the weakening of the articular structures, which is fraught with the development of permanent relapses. As consequences and complications should be distinguished predisposition to tears and dislocations.
Spinous process is damaged with sufficient whip load. Most often, fractures occur with retrograde damage. In this case, pain occurs during movement. If timely treatment is not available, then there are risks of developing epilepsy.
The arch of the vertebral column forms a hole in which there are many elements, such as processes and joints, functioning between each other. At the turn of the movement may be limited or difficult. The union of parts of the arc occurs for a long time, while the victim is in the prone position throughout the entire recovery period.
Displacements and dislocations
In this case, not only changes in the integrity of the segments, but also those of the spinal cord can be observed. In order to return the vertebrae to the site often requires surgery, which involves the installation of pins.
Among the effects of dislocations and displacements should be highlighted spondylolisthesis and distortion. These disorders occur as an echo in the near future, which is associated with gradual dysfunctions of the ligamentous apparatus and a slow displacement of the vertebrae to the side under pressure of the body. Such abnormalities are fraught with pinching of the spinal cord, nerve plexuses and arteries.
Spinal cord injury
Intervertebral disc injuries, depending on severity, are divided into the following types:
- Functional disorders of the spinal cord with remission.
- Permanent changes caused by the pathological process.
- Squeezing of the spinal cord by the processes of the vertebral segments after the inflicted injury.
The spinal cord after injury loses the main functions - motor, reflex and sensitive. In this area are located the nervous ganglia, which are responsible for the functioning of the internal systems and organs. Signs of injury primarily depend on the number of damaged structures and the duration of the damage.
Signs depending on the area of damage
Trauma to the cervical spine is life threatening. It is in this area that the dislocation of Atlanta arises. At the initial stages, this process does not manifest itself. Occurs when falling upside down, during sports and as a result of cervical osteochondrosis. If the injury occurs in 3-4 vertebrae, then the patient has tetraplegia - paralysis of the limbs. The diaphragm and respiratory muscles suffer, which can lead to complications such as respiratory arrest. The cause of such deviations may be a birth injury of the cervical spine.
When the segments in the lower back and sternum are broken, they are accompanied by weakness in the legs. This worsens the function of the pelvic vertebrae, the pelvic organs and the urogenital system.
Natal (birth) injuries represent a whole group of mechanical damage arising during the birth process. In recent years, they are much less common. The consequences of spinal injury in this case fall on the cervical region and will consist in the development of such deviations as an elongated neck or torticollis.
Diagnosis and treatment
It is recommended to take measures when the primary symptoms of spinal injury appear. In case of emergency, it is necessary to provide the victim with first aid in the form of fixing the damaged area and anesthesia. The speed of recovery depends on the speed of treatment.
Spinal injury treatment is carried out:
- In a conservative way. With a slight degree of damage, anti-inflammatory, hemostatic, and anesthetic drugs are prescribed. Appointed local massage classic and exercise therapy in order to restore and strengthen damaged and other elements.
- With the help of surgery. The operation is carried out in the form of a closed reposition and immobilization.
Rehabilitation after a spinal injury involves wearing orthopedic corsets or collars. Do not forget about maintaining physical activity and proper nutrition.
Acquired or birth trauma of the cervical spine and its other segments is a dangerous condition that requires timely medical assistance. The sooner the diagnosis is carried out and the treatment prescribed, the lower the risk of complications.