One of the unpleasant pathologies of the bone apparatus is spinal canal stenosis. The disease is associated with a decrease in diameter in the spinal canal, where the human spinal cord passes. Due to the narrowing of the diameter in the canal, structural units located in proximity to the spine are compressed, and the roots of the spinal cord are affected, causing symptoms.

Spinal stenosis is classified as a chronic pathology with slow progression, mainly in the lumbar region. To treat the initial stages of the disease, conservative methods are used, including exercises and ERT. To cure advanced stages of spinal stenosis, surgery is prescribed. The category of men over 50 years of age is susceptible to pathology, although congenital forms of the disease also occur.

Features of anatomy

Based on human anatomy, there is a canal in the spine that ends at the lumbar level with the “horse tail,” a group of nerve processes extending from the spinal cord. The norm for the anterior-posterior diameter (sagittal) in the lumbar region is from 15 to 25 millimeters, and the transverse diameter is up to 30 millimeters.

Spinal stenosis leads to a narrowing of the canal, which is expressed by symptoms of the pathology. A narrowing of up to twelve millimeters in sagittal dimension causes relative stenosis with minimal manifestations. A decrease in the canal to ten millimeters is the beginning of absolute stenosis with a classic picture of the disease.

Anatomically, the spine is formed by such units as the body, vertebral arches, connected by ligaments. Inside the formed vertebra passes the spinal cord with branches of nerve roots, vessels on both the left and the right side. The spatial capacity located in the spinal canal is filled with cerebrospinal fluid, and there is also fatty tissue there. The formation of the layer is necessary to protect the brain and nerves in the spine.

In case of minor injuries or curvatures of the spine, the formed layer is compensated by a narrowing of the canal, but with prolonged exposure the protection is weakened and spinal canal stenosis begins to form. Compression occurs on the nerve roots, and if the disease is not treated, then on the brain itself. The pathology causes neurological symptoms that are more pronounced either on the left or on the right side, depending on where the nerve roots are pinched.

Forms and causes of the disease

The causes of stenosis depend on the type and form of the disease. In practice, congenital and acquired stenosis occurs. There are also three forms of the disease:

1. The central form, in which the anterior-posterior size decreases.
2. Lateral spinal canal stenosis, in which the area where the nerve roots exit on the left and right sides, located between adjacent vertebrae, narrows. Lateral stenosis leads to a narrowing of the root canal to four millimeters or less.
3. A combined form characterized by reduction in different sizes and areas.

Congenital spinal stenosis is formed even before birth in the mother’s body. It is associated with an enlarged or reduced vertebral arch, as well as with its thickening or shortening of the pedicle and other structural units.

In most cases, spinal canal stenosis can be found in an acquired form. The causes of stenosis lie in a person’s lifestyle and injuries. Here are the main groups of reasons:

In practice, there are cases of congenital stenosis, which, when exposed to factors, is combined with acquired narrowing of the spine.

Symptoms

Symptoms of stenosis depend on the type of narrowing. This may be a narrowing in the canal itself or in the foraminar foramen. Sometimes stenosis occurs in the cervical spine, then vertebral artery stenosis may appear. This condition can interfere with blood circulation to the brain and cause complications. Brain function is disrupted, jumps occur blood pressure. Exercise and massage reduce the impact of the stenosis, but sometimes the option to treat the patient is surgery.

With stenosis in the lumbar spine, neurological symptoms occur when the nerve roots or spinal cord are damaged. A sign of pathology is a specific lameness. Pain, numbness and weakness in one or both legs appear when the person walks. Both legs are affected, as spinal stenosis impinges on the nerves on both the left and right sides.

Lameness resulting from pain forces a person to stop to sit down or even lie down. This will help relieve symptoms for a while.
The diagnosis uses a test in which the pain subsides when the patient easily bends his legs at the hip and knee. As stenosis progresses, gait becomes impaired and the person begins to walk in a bent position.

Canal stenosis is characterized by symptoms of pain in the lumbar region, sacrococcygeal joint. The nature of the pain is dull, radiating to the leg. When the nerve roots are pinched, the pain spreads “like stripes” along both legs. Diagnosis involves exercises with leg elevation, which may increase or decrease symptoms.

The disease is characterized by impaired sensitivity in the lower extremities. When touching the leg, sensitivity decreases, a feeling of “crawling goosebumps” and a burning sensation appears. Sometimes symptoms spread to the groin area and genitals, which affects erection and sensation.

If the disease is not treated, the effect on the spinal cord, nerves and blood vessels leads to disruption of the functioning of organs located in the pelvis. Urination, defecation and potency are impaired. Attacks of cramps in the legs, caused by the load of walking, also occur. Over time, leg muscles lose their strength and performance deteriorates.

In general, the disease progresses slowly, and if stenosis is treated in time, complications can be avoided. Advanced cases cause disability, in which seizures become frequent and the person cannot walk for a long time. The legs become thinner, and there is a threat of paresis and paralysis.

Diagnostics

Stenosis can be treated only after a comprehensive examination, since most symptoms are characteristic of many diseases, including hernias and osteochondrosis. The patient's complaints are studied and his anamnesis is collected, starting from an early age. The doctor should pay attention to the presence of lameness and specific symptoms.

Upon examination, the presence of tactile deviations is established. But to make a diagnosis, a hardware examination of the spine is required. An X-ray examination is prescribed, performed in different projections, to study the condition of the canal on both the left and right sides. The doctor may prescribe a CT and MRI examination.

X-rays can reveal the presence of osteophytes and a reduced intervertebral space. The structure of the spine is studied and various deviations are identified. This is necessary to properly treat the pathology and prevent complications. The appointment of myelography and scintigraphy is required in advanced conditions, with neurological abnormalities in the body.

Treatment

Spinal stenosis is treated in two ways:

1. Conservative treatment includes the selection of medications, a course of physiotherapy, massage and exercises for recovery.
2. The operation is prescribed in the presence of concomitant pathologies, complications and ineffectiveness of drug treatment.

Drug therapy is used in the early stages of the disease and is effective when all prescriptions are followed. It is important to combine massage courses and ERT, do exercises for the spine. To get rid of pain and inflammation, a group of NSAID medications is prescribed. They eliminate pain syndrome and reduce swelling. The doctor may prescribe Ibuprofen, Diclofenac, Lornoxicam and their analogues. When taking NSAIDs, pay attention to the expiration date so as not to harm the body.

Muscle relaxants are used to treat spinal pathologies. Among them, such remedies as Midicalm and Sirdalud are usually recommended. The drugs are prescribed by the doctor, observing the dosage and expiration date. Vitamin therapy consists of vitamins B, C, D. Combination agents such as Neurorubin can be used. In advanced cases, hormonal, vascular agents and decongestants are indicated.

If it is impossible to perform exercises and massage due to pain, then the doctor may prescribe blockades with hormones and Novocaine (Lidacaine).

Treatment of spinal stenosis with surgery is aimed at decompressing the nerve endings and the brain. Microsurgeries and full interventions are performed under general anesthesia.

After the operation, you are prescribed to wear a corset, and in the future you should perform exercises for your back. A disease such as stenosis disrupts gait and posture, so exercises and massage are recommended to be carried out in courses twice a year. Also, in the first time after surgery, NSAIDs and other analgesics are prescribed. It is necessary to follow the doctor's recommendations on dosage and monitor the expiration dates of the drugs.

2016-08-23

Neck dislocation: symptoms and treatment of sprain (photo)

Due to the fact that the cervical spine is the most mobile, neck dislocation is a fairly common occurrence. In medical reference books, this injury is called “prolapse of the cervical spine capsule.”

This injury is very dangerous, since it is typical not only of displacement of articular surfaces and vertebrae, but also of internal processes, stretching of muscle tissue and ligaments.

As a result, damage to the substance and membrane of the spinal cord almost always occurs. Considering these points, we can confidently say that a dislocated neck is a direct threat to human life.

In what situations can you get injured?

The cause of neck dislocation and damage to its ligaments can be:

• Road traffic accident.
• Ice skating and skiing.
• Headstand exercises.
• Diving in untested bodies of water.
• Somersaults in physical education lessons.
• Injuries received from sports equipment.
• Involuntary arching of the neck with sudden raising of the head during sleep.

Unfortunately, neck dislocation and ligament sprain are often accompanied by a fracture of the cervical vertebrae.

Different types of dislocation are classified according to the mechanism of injury, location of injury, and degree of displacement.

1. Anterior and posterior dislocations.
2. Single-sided and double-sided.
3. Incomplete and complete.
4. Linked.
5. Sliding.
6. Tipping.

It is quite difficult to get a dislocation and sprain in another part of the spinal column, which is due to its structure. The spine is the foundation of the human body, therefore all vertebral joints are firmly connected to each other using ligaments and intervertebral discs.

Due to the fact that the joints of the cervical region are actively working, and the ligaments are flexible, the human neck is capable of turning, bending and tilting, that is, it is very mobile. Neck dislocation most often occurs in the first vertebra.

Symptoms of a dislocated cervical vertebra

Since cervical spine dislocations have various forms, the symptoms of each of them have their own individual characteristics.

• With a unilateral neck dislocation, the head tilts in the direction opposite to the displacement.
• With bilateral cervical dislocation, the head tilts forward.
• The patient experiences severe pain, which intensifies every day.
• The pain becomes more intense when the head is in a horizontal position.
• It becomes impossible to turn and tilt your head. This can only be achieved by holding the head with your hands.
• Patients diagnosed with a dislocation of the cervical spine are forced to turn their entire body if necessary to turn their head.
• These symptoms include crepitus, headache, dizziness, and darkening of the eyes.
• The pain may radiate to the arm or shoulder joint.

However, when making a diagnosis, doctors do not rush to a final conclusion, since the symptoms of a neck dislocation are quite similar to the signs of myositis and osteochondrosis, osteoarthritis of the spine.

Usually, to clarify the diagnosis, already at the first appointment, the doctor sends the patient for an x-ray. Although a dislocation is not always detected on x-rays, the displacement of the head in relation to the cervical spine is quite clearly recorded.

Based on these signs, the doctor can determine a dislocation of the neck.

If a patient has the above symptoms, there is every reason to suspect this particular injury, so the person should immediately see a traumatologist. Neglect of the problem can result in sprains and contracture of tendons and muscles, and these are already irreversible phenomena:

1. the neck becomes crooked;
2. The patient's head is always tilted to one side or forward.

Diagnosis and treatment of neck dislocation

Today, for a more accurate diagnosis, the spondylography method is used (x-ray of the spinal column without prior contrast).

If it is not possible to immediately make a diagnosis, and all symptoms indicate the presence of a dislocated neck, the examination is performed through the oral cavity.

The doctor is absolutely convinced that a neck dislocation is present if the following pathological changes are observed on the photographs:

• displacement of articular surfaces;
• unilateral reduction in the size of the intervertebral disc;
• asymmetrical position of the first vertebra.

Neck sprains and dislocations can be treated with both conservative measures and surgery. Conservative methods include:

1. skeletal traction by the parietal tuberosities;
2. one-stage closed reduction using a Glisson loop;
3. reduction using the Richet-Hüther method.

Conservative therapy is indicated in the acute phase of damage.

Treatment of children

If a cervical spine injury is diagnosed in a child, an experienced doctor performs a one-step reduction of the vertebra, for which the doctor uses a special Glisson loop. First, the traumatologist makes careful rotational movements, tilting the patient's head to the right and left, back and forth.

During such manipulations, a crunching sound is clearly audible; this is characteristic of repositioning the vertebra to its anatomical place. The procedure is performed only by a doctor who has sufficient experience in operating traction equipment. The doctor stays next to the patient all the time and gradually increases the load on the device.

If a sudden sharp crunch appears, the doctor immediately eases the load and sends the child for a repeat x-ray. Treatment of old neck injuries is carried out using a Crutchfield brace. This procedure is much more serious and requires drilling blind holes in the skull.

After repositioning, the tissue around the affected vertebra will certainly swell. After swelling subsides, it is recommended to apply plaster or plastic thoracocranial orthoses.

The child must wear such a device for two months. In about three months, the cervical spine will fully recover.

How to treat a sprained or dislocated cervical spine in adults

Emergency measures include providing the victim with complete rest and immediately transporting him to a medical facility. With such injuries there is always a risk of damage to the spinal cord.

At the clinic, the patient will have an X-ray, the vertebra will be realigned and an immobilizing bandage will be applied for 4-6 months. Some doctors prefer to perform vertebral adjustment without anesthesia. They explain this approach by the fact that the doctor can control the patient’s sensations during the procedure.

Reduction occurs as follows:

• the doctor first tells the patient about possible pain syndromes and his manipulations;
• the patient is seated on a chair;
• the doctor takes the patient’s head and begins to lift it, thus the patient’s body turns out to be a natural counterweight;
• The doctor does not stop his actions until the vertebrae are in place.

After this procedure, the patient is prescribed a course of physiotherapeutic measures.

In their practice, doctors sometimes resort to realignment of the cervical spine using the Richet-Hüter method. The essence of this technique is as follows:

1. the patient lies with his back on the couch in such a way that his head and neck hang down;
2. a solution of novocaine is injected into the diseased area;
3. the doctor applies a Glisson loop and fixes it on his lower back, while the doctor holds the patient’s head with his hands;
4. The medical assistant stands opposite and holds the patient’s neck with his hands (the edges of the assistant’s palms should be on the border of the injury);
5. the neck gradually stretches along the axis, and the doctor begins to tilt it in the healthy direction;
6. With utmost care, the doctor turns the patient’s head in the direction of the dislocation, as a result of which the vertebra should return to its place.

If these techniques are ineffective, surgery is indicated for the patient.

What is hyperlordosis and how to prevent its occurrence

Lordosis is a curvature of the spine of a natural (physiological) or pathological (painful) nature with a convexity forward. Natural lordosis is an anatomical feature of every person. Hyperlordosis is a pathologically curved spine. In medical practice, the term “lordosis” means precisely too much bending of the spinal column as a result of injury, disease or incorrect posture.

Hypelordosis is a disease of the modern world, when physical labor has been replaced by intellectual labor, and the production process has ceased to require human effort. The consequence was a decrease in motor activity, weakening of muscles and, as a result, poor posture.

Curvature of the spine is a consequence of weakened back muscles, decreased strength of muscle contraction, inability or unwillingness to monitor posture.

General description of the disease, its characteristic features

In medical practice, it is customary to classify hyperlordosis by type, origin, shape and degree of mobility of the spine.

Spinal column of any healthy person has natural curves. Without them, it is impossible to maintain the body in an upright position. They act as shock absorbers when walking and running and help withstand significant physical activity.

As a result of injuries, diseases, pregnancy, an increase in physiological curvature is possible - hyperlordosis. Increased bending of the ridge in the lumbar area is a common consequence of displacement of one of the lumbar vertebrae, congenital bilateral femoral dislocation, or rickets.

Cervical hyperlordosis can develop as a consequence of other pathologies, and as a result of thermal and chemical burns, which cause deformation of the cervical vertebrae and scars that tighten the neck.

With this pathology, the spinous processes of the vertebrae come closer together, the vertebrae themselves diverge, and the load on the intervertebral discs increases manifold. Poor posture is the easiest consequence of the disease. With the development of hyperlordosis, dystrophic processes with severe pain syndrome develop in the intervertebral discs.

Symptoms

In medical practice, there is the term “lordly posture”, by which an experienced diagnostician can determine pathology with sufficient confidence. Its signs include:

All of the above signs are of a general nature. Each type of disease has specific symptoms. Highlight:

1. Thoracic hyperlordosis. Curvature of the spine in the thoracic region, a rare form of pathology. In advanced cases, the shoulder blades protrude strongly forward, resembling the folded wings of a bird.
2. Cervical hyperlordosis. With severe stoop, the neck is stretched forward, and as the disease progresses, it becomes noticeably shorter. The shoulders are shifted and lowered.
3. Hyperlordosis of the lumbar spine is the most common form. In the lumbar region, the spine noticeably bends forward, the stomach is protruded, and the angle of the pelvis in relation to the spine is increased.

Causes of the occurrence and development of the disease

In medicine, the following classification of this pathology is accepted:

1. By origin (congenital, acquired, secondary, primary).
2. By form (natural, pathological).
3. According to the degree of mobility of the spine (fixed, unfixed, partially fixed).

Each type and form has a specific origin, clinical course, and symptoms. Common reasons for their development include:

• neoplasms of benign and malignant nature, cancer processes;
• congenital diseases, injuries;
• postural disorders in childhood and adulthood;
• incorrect posture when reading, working at the computer.

Trauma and fractures are considered as one of the reasons for the development of the primary pathological form of hyperlordic curvature of the spine. Including gunshot fractures, which provoke putrefactive processes in the joint tissues and lead to joint defects. A number of diseases have also been identified that increase the risk of developing lordly posture:

1. Neoplasms of benign and malignant nature. Thus, with osteosarcoma with an initial focus in the spinal column, an increase in the size of the joints occurs, and as the process metastasizes, the shape of the vertebrae changes.
2. Bacterial and mycobacterial damage to bone tissue and bone marrow.
3. Spondylolysis.
4. Spinal tuberculosis.
5. Osteochondrosis.
6. Chondrodystrophy.
7. Pregnancy. In pregnant women, lordic manifestations are transient and disappear over time.
8. Deforming endemic osteoarthritis, urovsky disease.

Prerequisites for the development of pathological curves are age-related changes in bones, excess weight with deposition of a fat layer in the abdominal area. The last factor is closely related to a sedentary lifestyle, unhealthy and irrational diet.

Thus, there are three groups of cause-and-effect relationships:

1. Objective – age-related and pregnancy-related.
2. Bound by an incorrect lifestyle.
3. Occurring against the background of other diseases, injuries, prolonged bed rest.

Congenital and acquired

The primary form is a consequence of painful processes in the spinal column and spinal muscles. Occurs due to abnormalities in the intrauterine development of the embryo, birth injuries or injuries to the woman during pregnancy.

The secondary form is the result of diseases of the hip joint, a lack of certain microelements, and pregnancy. Thus, with dysplasia of the hip joint, the compensatory function of the spine is activated, trying to adapt to changed conditions and maintain its shock-absorbing ability. In this case, the root cause is treated. And then there’s hyperlordosis itself.

Congenital hyperlordosis of the cervical-collar zone is always the result of abnormal development of the embryonic skeleton or birth trauma.

Acquired cervical hyperlordosis can equally develop in both men and women and is a consequence of:

• Bekhterev's disease;
• herniated intervertebral discs;
• osteochondrosis or rheumatoid arthritis of the cervical area.

Spondylitis, radiculitis, and hormonal system disorders lead to cervical lordosis.

How possible reasons are considered:

• constant long-term spasms in the neck muscles;
• overweight and obesity.

For the same reasons, thoracic hypolordosis develops.

Congenital lumbar hyperlordosis is rare. The impetus for the development of pathological curvature of the spinal column is anomalies in the formation of the fetal skeleton, trauma to a woman during pregnancy, or birth trauma. Hyperlordosis of the lumbar region is inherited and can manifest itself after several generations.

The mechanism of development of the secondary form of lumbar hyperlordosis is triggered by pathological processes of the musculoskeletal system, injuries of the legs, hip joints, spine, and disorders of a genetic nature.

Among the forms of acquired disease there are the following types hyperlordosis:

1. Rachitic. Appears in children either in the first months after birth or in the first year of life. It develops as a consequence of a lack of vitamin D, which, in turn, leads to disruption of the metabolism of phosphorus and calcium, the main bone-forming element. Leads not only to hyperlordosis, but also to other irreversible joint deformities.
2. Paralytic The result of systemic autoimmune diseases of muscle, bone, joint tissue, invasion of infectious agents, calcium deposits in bones and joints and the formation of calcifications. As the most common cause of the development of pathological lordosis, various types of myositis, poliomyelitis, and in children - cerebral palsy are noted.
3. Traumatic. The consequence of dislocations and disorders of the connective tissue of the hip joint - with lumbar hyperlordosis; ankylosis, fractures inside the joint, open injuries with purulent discharge, unsuccessful surgery.
4. Functional. The problem of childhood and adolescence is when the growth of bone tissue outpaces the growth of muscle tissue. Bones become deformed without the support of a muscular corset.
5. Compression>Prevails in people of middle and older age groups. Age-related changes in bone and joint tissue and diseases leading to pathological changes in the vertebrae are considered as the main causes.

Classification by age

Hyperlordosis can develop at any age. The following types of this disease are distinguished according to the age characteristics of patients:

1. Infant. First of all, the congenital form of the pathology is considered. Develops during embryonic development with improper formation of the vertebrae. Infantile hyperlordosis is a common result of rickets.
2. Children's. A consequence of constantly incorrect posture during home and school activities. The cause of lordly posture in children is flat feet, when the shock-absorbing functions of the foot are lost. The load falls on the spine, the shoulders move forward, and a specific “duck” gait develops.
3. Youth and adolescence. Appears at puberty, when hormonal release causes rapid growth of bone and joint tissue. And the build-up of skeletal muscles lags behind. Curvature of the spinal column in adolescence and early adolescence is a consequence of incorrect posture. Teenagers are often embarrassed by being too tall, shift their shoulders, lower their heads, and this pose becomes habitual. The spine “remembers” it.
4. Adult. It develops against the background of other pathological conditions, with injuries, constant wearing of high heels, and very long periods of bed rest.
5. Senile, or senile. Age-related changes in joint and muscle tissues are considered as the causes. With age, strong, elastic muscles become loose; a weak muscular system is not able to provide the joints with proper support. Diseases that have accumulated throughout life and caused complications in the lumbar, cervical or thoracic region also lead to senile hyperlordosis.

Diagnostics

It is based on anamnesis, initial examination, and instrumental examination. During a medical examination, postural abnormalities are identified and special testing is carried out, the purpose of which is to determine the presence or absence of neurological abnormalities. The spinal muscles are examined by palpation.

A mandatory instrumental examination procedure is radiography of the spine in two projections – direct and lateral. The degree of curvature is determined by the patient’s ability to bend and straighten his back as much as possible. X-ray reveals the degree of mobility of the spinal column and destructive changes in the vertebrae.

If it is suspected that the curvature is the result of diseases of a somatic nature, computed tomography, magnetic resonance imaging and scintigraphy are performed. With the help of the latter, changes in tissues are differentiated from infectious processes, malignant and benign tumors.

In addition to the above, there is a “folk” diagnostic method:

1. Stand with your back to the wall.
2. Place your hand between the wall and your lower back. The hand can pass heavily, freely, or not at all.

The last two cases are pathological. A sign of increased or, conversely, smoothed lordosis. The first option is the norm.

How is the treatment carried out?

Manual and conservative therapy, massage, therapeutic exercises are the methods used to treat lordosis.

The therapeutic technique depends on the nature of the curvature. If the pathology is the result of an infectious lesion, benign neoplasm or other disease, the pathology itself is eliminated first. If you are overweight, a special diet is prescribed.

Drug therapy

It is impossible to cure spinal curvature with medications. The use of medications is indicated in cases of increased pain. To relieve pain attacks, the use of drugs with an analgesic effect is indicated.

To achieve the greatest effect, medications are used in conjunction with physical therapy exercises, massages, and manual therapy. Medicines are intended for single use and the course of their administration does not exceed 14 days. The most popular drugs include Sedalgin, Paracetamol, Diclofenac, Ibuprofen.

For moderate pain, it is enough to take the drug once a day; in case of severe pain, the daily dose is increased to three doses.

Physiotherapy

It is a set of specially designed exercises. Therapeutic exercises help prevent the progression and increase in joint deformation, relieve pain, and strengthen the back muscles.

The photo below shows a set of exercises for lumbar lordosis.

The exercises are not difficult, they won’t take too long large quantity time and will not take much effort.

1. Feet shoulder width apart. Hands at your sides. As you inhale, bend over and try to touch your feet with your palms.
2. Stand against the wall, press your shoulder blades, buttocks and heels tightly against it. Without tearing away the points of contact, try to straighten your back as much as possible.
3. Stand with your arms extended down. Bend over, grab your knees and try to touch them with your forehead.
4. Take a deep breath and do a squat with your arms extended forward.
5. Lie on your back. Extend your arms to the sides. Raise your legs as high as possible and try to throw them behind your head. Stay in this position for a few seconds.
6. Lie on your back, arms extended. With your back as straight as possible, touch the floor with your lower back.

This exercise must be done daily. Initially, each exercise is performed two to three times, then their number is increased to five to ten.

The effectiveness of therapeutic exercises increases if a set of physiotherapy procedures is used simultaneously with it. Baths with herbal infusions, pine, juniper, cedar needles, paraffin applications and applications with ozokerite - a natural mineral wax - have a therapeutic effect. Such pads relieve spasms and inflammation. The procedure takes 10-15 minutes.

In the video you can see a more detailed set of exercises for the treatment of this pathology.

Massage

Massage sessions performed by a specialist eliminate pain in all areas of the spine, pain in the back muscles, and eliminate numbness.

Massage procedures are carried out either before meals or two hours later. For greater effectiveness, medications are rubbed into the skin: Viprosal, Apizatron, Fastum gel. The course and duration of massage sessions depend on the patient’s condition, form and location of the disease.

Manual therapy

The main difference from massage is the equal impact on muscles and joints. Conducted by a vertebrologist. The procedure not only solves a number of problems with the spine, but also improves blood circulation, tightens and maintains muscle tone. It is more effective than drug and hardware treatment.

During a manual therapy session, two methods are used: soft, using muscle-energy techniques, and hard, using the impact force of the hands.

Consequences of the disease in the absence of timely treatment

The initial stages of hyperlordosis give a favorable prognosis. Increased bends can be corrected without serious consequences. The inability or unwillingness to follow the doctor’s prescriptions and recommendations leads to an increasing increase in deflections and the formation of a hump, the removal of which is a long and difficult procedure.

Hyperlordosis provokes the formation of hernias and pinching of the sciatic nerve. Subsequently, the limbs become numb and lose sensitivity. Due to severe pain and inability to move independently, the person needs a wheelchair. Due to loss of tone in the muscles, atrophy processes begin, nerve endings lose vitality and die, leading to paralysis.

As the pathological condition develops, lung volume decreases, breathing becomes difficult, and pain occurs even with minor physical effort. The heart is overloaded, the internal organs are compressed, and pain appears in the intercostal space. There may also be prolapse of the kidneys and problems with the formation and separation of urine.

Prevention

Spinal curvature is easier to prevent than to treat. Treatment is a long process, but for prevention it is enough to have 10-15 minutes of free time. Both therapeutic and preventive measures include:

1. Exercises that develop and strengthen the back muscles. Weak muscle support is a factor provoking the development of pathological curvature. Regular swimming, yoga, rhythmic gymnastics, and dance classes will ensure a straight back, beautiful posture, and a healthy spine.
2. Balanced diet. Baked goods, high-calorie sweet dishes, everything fried, smoked, pickled lead to inevitable weight gain. The higher the weight, the larger the ridges of fat on the abdomen, and the harder it is for the spine to cope with the load. The menu includes foods rich in vitamins, minerals, and microelements. For children, it is important to get calcium into the body - the main “builder” of the body’s joints.
3. Properly selected shoes. Constantly wearing high heels is a direct path to strengthening the curves of the spinal column.
4. Tracking posture while working, watching TV, doing household chores. This applies to both children and adults. Curvature is possible at any age, but in children, with a weak skeletal frame, changes can become irreversible.

Spinal cord injuries most often occur with spinal fractures. When the motor cells of the spinal cord horns (trauma, poliomyelitis) and their fibers are damaged, peripheral (sluggish) paralysis or paresis. Patients are on bed rest for a long time. Depending on the location of the lesions, motor dysfunction varies: when localized in the cervical region, spastic tetraparesis and paralysis occur; in the lower cervical and upper thoracic – flaccid paresis (paralysis) of the arms and spastic paresis (paralysis) of the legs; V thoracic region– spastic paralysis (paresis) of the legs; in the lower thoracic and lumbar – flaccid paresis (paralysis) of the legs.

Objectives of exercise therapy and massage

Activation of the cardiovascular and respiratory systems; improving the conduction of motor and sensory impulses; strengthening paretic and stretching contracted muscles (for contractures); prevention of muscle atrophy; strengthening the muscle corset; development of compensatory motor skills.

Features of exercise therapy

PH includes general developmental, breathing, corrective, resistance, reflex and ideomotor exercises. Exercises in water are shown. For tetraparesis, breathing exercises, ideomotor and passive movements in the upper and lower extremities are used; after spinal surgery – positioning treatment, breathing and passive exercises.

Severe lesions of the cervical spinal cord. At an early stage, the patient is periodically turned on his back, side, or stomach. When movements in the joints of the arms are limited, they are either brought towards the body or abducted, the arms are periodically bent and extended at the elbow joints, the wrist joints and fingers are fixed with a bandage to a plywood splint in a straightened state. The patient's feet are placed in the box so that they rest against its wall at an angle of 90 degrees. When the tone of the shin flexors increases, the knee joints are fixed to the bed in the extension position. To transfer the patient to a vertical position, orthostatic reactions are trained for a long time and gradually. The patient is placed on a rotating table, the torso, pelvis and legs are fixed with belts. Slowly change the tilt of the table under the supervision of a doctor. Next, they begin to sit the patient up in bed without lowering their legs. Then one and the other leg are lowered one by one, and they are seated with their legs lowered, resting on a pillow; perform exercises for the muscles of the shoulder girdle and head. Later, the patient is transferred to a wheelchair, and the time spent in it is gradually increased. At the same time, the patient is taught the simplest actions with paretic hands using various objects and devices. Gradually the mode of movements is expanded. In a corset and orthopedic devices, the patient is lifted to his feet, supported. Later, they teach walking using apparatuses, and then with the help of special walkers and crutches.

Massage

They start from the chest, using all the techniques, but rubbing and vibration are done gently. Then they stroke and rub the back (to improve the trophism of the lower extremities, massage the lumbar region, and the upper - cervicothoracic region) and massage the limbs. Features: for flaccid paralysis, in contrast to massage of spastic muscles, kneading, vibration and effleurage techniques are widely used; If pain appears from a deep massage, then switch to vibration massage with the fingertips. The duration of the procedure is 10-20 minutes. The course of treatment is 10-12 procedures in the subacute period of injury.

Approximate list of exercises for spastic paresis of the lower extremities

• Abduction and adduction of the leg at the hip joint in the supine position with the leg suspended on a towel or on a smooth surface that reduces friction.
• Flexion and extension of the leg at the hip joint in IP lying on the side with the leg suspended.
• Flexion and extension of the leg at the knee joint in the IP lying on its side with the hip fixed by the hands of the instructor; flexion and extension of the leg at the ankle joint with the shin fixed by the instructor, the leg is half bent at the knee joint.

Diseases and injuries of the peripheral nervous system

The peripheral nervous system includes nerve roots, spinal nodes, nerves and their plexuses. Injuries often affect superficial peripheral nerves. There may be a concussion, bruise or nerve break, complete or partial. In case of damage to the peripheral nervous system motor disorders (paresis or paralysis), sensitivity disorders (hypoesthesia or hyperesthesia), vasomotor trophic disorders (skin cyanosis, sweating disorder, skin depigmentation, etc.) occur. The clinical picture depends on which part of the nerve is involved in the inflammatory or traumatic process. When the main trunk of the nerve is damaged, all its functions are lost.

Neuritis– peripheral nerve disease of traumatic or infectious-inflammatory etiology. In the area innervation of the nerve, blood circulation is disrupted, which prevents the removal of inflammatory products and the penetration of drugs into the lesion, and motor and sensory disturbances are noted. Polyneuritis can be a consequence of intoxication (alcohol), vitamin deficiency, infections, metabolic disorders (diabetes) and are manifested by flaccid paralysis of the limbs and impaired sensitivity in them.

Radiculitis- inflammation of the nerve roots. Plexit- inflammation of the nerve plexus.

Objectives of exercise therapy for damage to the peripheral nervous system: improved blood circulation; stimulation of nerve regeneration; strengthening paretic muscles and ligaments; elimination of contractures and joint stiffness; stimulation of substitution movements.

The human spinal cord plays a huge role in normal life. Spinal cord injury is very dangerous as it can lead to complete disability of the patient. This condition cannot be ignored. Any back injury should be seen in a medical facility to avoid serious complications.

All contributing factors that can trigger spinal cord injury are divided into two main groups:

• pathological;
• traumatic.

TO pathological reasons relate:

• spinal cord developmental abnormalities;
• tumor-like formations;
• infectious diseases;
• circulatory disorders in the organ;
• osteoporosis;
• destructive changes in the spine;
• genetic pathologies of the nervous system.

Traumatic injuries are caused by:

• falling from height;
• hit on the back with a heavy object;
• car accident;
• a sharp turn or tilt of the body or head;
• falling of a heavy object on a person;
• gunshot wound.

The spinal cord is the most protected organ. In order to injure it, the integrity of the spine must also be compromised. Therefore, spinal cord injury is always accompanied by damage to the spinal column.

This includes:

• dislocation and subluxation of one or more vertebrae;
• compression of the spine;
• spine fracture;
• vertebral prolapse.

Spinal cord injury, the symptoms of this condition vary, depending on the nature and extent of the damage.

The main signs of spinal cord injury are:

• pain in the area of ​​injury;
• feeling of heat or cold;
• redness of the injury site;
• numbness of the back segment;
• complete or partial paresis of a part of the body located below the site of injury;
• pain in the heart area;
• cough that does not bring relief;
• increased sweating;
• patient anxiety.

Spinal cord injury is not classified as a separate block in the ICD-10 disease classifier. Pathologies are coded depending on the root cause of their occurrence.

Types of injuries

All spinal injuries are divided into open and closed.

When closed, the skin is not damaged. Open is characterized by the presence of a wound in the spine, in which bone fragments are visible.

Injuries to the spine and spinal cord are divided into three main groups:

1. Without disrupting the functionality of the spinal cord.
2. Spinal injury with dysfunction of the spinal cord.
3. Damage to the spine with complete rupture of the spinal cord.

Based on the nature of the damage itself, the following spinal cord injuries are distinguished:

• injury;
• shake;
• crushing;
• compression;
• hemorrhage;
• traumatic radiculitis;
• spinal cord rupture.

Each of these injuries has characteristic symptoms.

Hematomyelia

Hematomyelia means hemorrhage into the membranes of the spinal cord or the lumen of the spinal column.

Regarding the causes of occurrence, traumatic injury to the spine (fracture, prolapse, dislocation) comes first. The second contributing factor is pathologies of the blood and vascular systems (arterial-venous dystrophies, hemorrhagic vasculitis, thrombocytopenic purpura, in case of destruction of the vascular wall by tumors). Separately, I would like to highlight the formation of a hematoma against the background of improper medical procedures (epidural anesthesia, puncture).

Hematomyelia is characterized by the following symptoms:

• paresis of the upper and lower extremities;
• incontinence and urinary retention;
• radicular pain;
• disturbance of oculomotor function;
• loss of sensitivity in the groin area.

The prognosis for hematomyelia is often favorable. Functionality is restored gradually as the hematoma resolves. In case of extensive hemorrhage, surgical intervention is performed to remove the hematoma.

Root damage

Exercise therapy

Exercise therapy for spinal cord injuries plays an important role at the rehabilitation stage. Only through properly selected exercises and patience on the part of the patient can the functionality of the damaged areas be restored.

Exercises are selected individually, taking into account the severity and type of injury. Exercise begins 2-3 days after injury or surgery, regardless of the severity of the condition.

Classes cannot be done standing. Optimal poses: on your stomach, on your back, on all fours. All exercises are performed smoothly, without sudden movements or turns.

Massage

With a diagnosis of spinal cord injury, rehabilitation is not complete without a course of massage; it is an integral part of the recovery period.

Purpose of massage:

• improve blood circulation and tissue nutrition;
• restore motor function;
• restore reflexes.

Massage sessions should only be performed by an experienced specialist. Improperly performing the procedure can cause harm to the body.

Prognosis and prevention

The prognosis of spinal injuries that are not accompanied by disruption of the integrity of nerve fibers is generally favorable. If all the doctor’s recommendations are followed and the correct treatment tactics are selected, functional abilities are restored over time.

If a spinal cord injury in children and adults is accompanied by a partial tear of the trunk, loss of some functions is possible. In the case of a complete rupture, paralysis occurs below the injury site.

Preventive measures to prevent spinal cord injuries include:

• compliance with safety rules when working in industries, diving in water, working at heights;
• wearing comfortable, anti-slip shoes in winter;
• preventive examinations by a doctor to avoid pathological damage to the spinal cord;
• correct, active lifestyle.

The consequences of a spinal cord injury are unpredictable. With severe damage, complete paralysis and even death are possible. At the slightest back injury, you need to contact a medical institution for differential diagnosis and selection of treatment tactics.

In recent decades, medicine has seen a significant change in views on the treatment of patients with spinal cord injuries (the so-called spinal patients), which has made it possible to achieve much more effective and complete rehabilitation.

The rehabilitation of spinal patients is based on a functional approach, first developed by V. Krasov, and then supplemented and improved by V. Dikul. The essence of their technique is based on the premise that the regenerative processes in the spinal cord are much more advanced than was commonly thought. To launch them effectively, constant motor exercises are necessary, and the powerful flows of proprioimpulses that arise during their implementation are a stimulus for the synthesis of new nervous structures and the blazing of new neural pathways. The effectiveness of muscle load in this case is determined by two main factors - the formation of a personal attitude towards the success of treatment and an orientation towards one’s own responsibility for achieving this success, i.e. The didactic principle of consciousness and activity implemented in this case allows the patient to overcome both painful sensations and fatigue.

Exercise therapy for spinal cord injuries is structured according to periods.

In the first (acute) period in a hospital, the patient is placed on a special “functional” bed or on a bed with a wooden “board”, on top of which a water or ordinary mattress is placed. The head end of the bed is raised from the floor level by 20-60 cm. The victim is placed in a supine position, traction is carried out for injuries below the fifth thoracic vertebra by straps placed in the axillary areas, and in case of damage above the fifth thoracic vertebra - using a Glisson loop. Gauze strips are placed on the soles of the feet and the feet are suspended.

Objectives of exercise therapy for spinal cord injuries in the first period.

• 1. Normalization of the patient’s mental state and formation of a mindset for rehabilitation.
• 2. Stimulation of the regeneration of nerve structures and the creation of new nerve pathways in the central nervous system.
• 3. Prevention of muscle atrophy and contractures.
• 4. Prevention of bedsores and congestion in the blood circulation and lungs.

Despite the serious condition of the patient, it is recommended to start therapeutic exercises as early as possible - almost immediately after the patient recovers from the shock state. Practice shows that any delay in starting physical exercise affects its effectiveness.

The methodological techniques used in exercise therapy vary depending on the nature of the change in muscle tone. For flaccid paresis and paralysis, physical exercises are used to strengthen weakened muscles. Passive exercises are used with caution so as not to cause joint laxity.

Considering the rapid exhaustion of weakened muscles, active movements are performed with a small number of repetitions in “fractional” doses, several times during the session. Passive movements are performed slowly and smoothly. For spastic paresis and paralysis, physical exercises are combined with elements of relaxing acupressure. Active movements are performed without much tension and alternate with relaxation exercises. Positional treatment is used (fixation of the lower extremities in a position of extension and some abduction).

In the first period, any means that stimulate metabolism, blood circulation, breathing, the functioning of nervous structures, etc. can be used. Of primary importance in this case are exercises that involve active muscle groups (including paretic ones), turning Special attention to those that are on the border with paralyzed areas of the body. At the very beginning, active muscle groups should be involved in work and passively stimulate idle ones. In this case, special attention is paid to general developmental special exercises for training the muscles of the shoulder girdle and back in the starting position lying on the back and stomach. As for the motor links in the affected area, here, in addition to traditional passive exercises - movements in the corresponding joints with the help of a physical therapy specialist, sending impulses, ideomotor, massage, etc. - various training devices are used that allow the patient himself, with the help of active muscles (mainly the shoulder girdle, ) act on the affected areas. This achieves not only the formation of a powerful flow of impulses from the affected area to the central nervous system, which in itself contributes to the regeneration of nervous structures and the creation of new neural pathways, but also provides a significant load for the body, which prevents the development of the consequences of physical inactivity.

A course of exercise therapy should begin with isolated movements, simple in structure and from simplified starting positions. Then increasingly and more intensively involve more and more new muscle groups in the work.

The most important condition for the success of the described exercises in the first period is their repeated repetition until pronounced signs of fatigue are necessarily achieved. It is quite acceptable to feel some pain during exercise.

To prevent the formation of bedsores, the patient should be turned from back to side during the day and, in this position, massage those areas of the body under which local blood stagnation and disruption of skin trophism are possible. If the patient is able to perform self-massage, he should perform this procedure many times.

Restriction of chest movements and forced prolonged lying on the back provoke congestion in the lungs, and therefore the most common complication of prolonged skeletal traction is pneumonia of the lower lobes of the lung. An effective way to prevent congestion is to perform dynamic exercises, and to prevent this complication in the lower lobes - diaphragmatic breathing (“belly breathing”).

Massage for spinal cord lesions performs a number of functions. In addition to its importance for preventing bedsores, it should be noted the effect of massage procedures on local blood circulation, which is of particular importance for areas of the body located in the zone of paralysis. Massage provides muscles located in these areas with increased tone and trophism, which prevents the possibility of consequences in the form of their atrophy. If sensitivity is impaired, creating a powerful impulse in the central nervous system from the massaged areas, massage contributes to its faster recovery. To solve these problems, massage should be performed deeply and energetically with the primary use of rubbing, kneading, percussion and vibration techniques.

From the very beginning of functional therapy, special attention is paid to instilling in the patient a sense of responsibility for the success of treatment and the formation of an attitude towards daily constant independent muscle activity in accordance with the program developed by the attending physician and exercise therapy specialist. In this regard, the use of elements of auto-training is especially effective, during which the corresponding formulas are mastered with a positive attitude towards the active behavior of the patient.

The patient’s mode of physical activity should be determined by the natural alternation of all these groups of exercises: active, passive, massage and self-massage, breathing, etc.

In the second (subacute) period the use of physical exercises should be determined by the following objectives of exercise therapy.

• 1. Further activation of motor activity of the affected areas of the body and limbs.
• 2. Stimulation of regeneration of affected nerve structures.
• 3. It is possible to completely eliminate the atrophies and contractures that have arisen.
• 4. Restoring the patient’s motor skills, primarily self-care and walking.

The onset of the second period corresponds to the stabilization of the body’s life support systems and the partial restoration of movements in the affected areas of the body. The specific duration of the first period and the time of transition to the second are determined by many circumstances: the location and nature of the spinal cord injury, the activity of the functional therapy used, etc.

Already at the beginning of the second period, the patient should be taught to independently turn on his stomach, then on his side, and subsequently on all fours (if there is no pronounced impairment of the motor activity of the shoulder girdle). In the future, exercises in support on the elbows and knees, on all fours, as well as moving on all fours with pulling up the legs using the torso muscles, are gradually introduced into the classes. While lying on your back and on your stomach, exercises to contract the buttocks and perineal muscles are recommended.

The patient is usually allowed to sit with his legs down, gradually increasing the duration of sitting from 1-2 minutes to longer times several times during the day. However, any change in sitting mode should be determined by the well-being of the victim.

When first trying to move to a vertical position, the patient may experience dizziness and even nausea due to the gravitational effect of blood flowing from the brain. Associated with a decrease in vascular tone. To restore it, before moving to a sitting position, already in a lying position, the patient should perform several exercises involving the large muscle zones of the lower extremities: static tension of the muscles of the thighs and legs, foot movements, bending the legs at the knee and hip joints, etc.

A serious stage in the rehabilitation of a spinal patient is his preparation for walking. It begins already in the position of him lying on his back, when he performs exercises to strengthen the muscles of the back, neck, shoulder girdle, as well as coordination exercises. The patient is taught to “walk lying down” with a displacement of the pelvis along with a straightened leg. When performing passive movements, the patient must be forced to send impulses to the paralyzed areas and mentally restore the lost movement. An equally important exercise is to teach the patient to contract the quadriceps muscles of the thighs. These exercises are given in significant dosage with multiple repetitions throughout the day and alternating their implementation with other exercises. When active contractions of the quadriceps muscle and active movement of the straightened leg due to the pelvis appear, the dosage of these exercises can be significantly increased.

The next stage of restoring the walking skill is standing on crutches (in a corset), and then walking successively on “walkers”, tripods, parallel bars, etc.

Learning to walk itself is carried out in three stages: the first - moving both legs forward and backward at the same time using the torso while resting on the hands; the second is alternately pulling up the straightened (in the apparatus and orthopedic shoes) leg using the pelvis with simultaneous retraction of the perineum and contraction of the buttock; the third is alternate movement of the straightened leg forward, backward and to the side.

At each stage of learning to walk, if the patient encounters difficulties associated with weakness of the muscular system of the trunk, he can first be offered to master the corresponding movements in a corset, with the help of an assistant, etc., but in each case, stimulating him to independence.

At the second stage of functional rehabilitation, exercises in a therapeutic swimming pool are very effective, which not only make it easier to perform movements with weak muscles, but also help normalize the patient’s emotional state.

Throughout the entire period, the role of massage remains important.

IN third period, the beginning of which corresponds to the free movement of the patient on crutches, the main task of exercise therapy is the most complete everyday and social rehabilitation of the patient.

Already at the beginning of the period, the patient is prescribed active movements in various parts musculoskeletal system in a standing position on crutches: pulling the straight leg up, moving the leg forward, to the side, back, pulling in the buttocks, perineum, bending the torso, etc.

After the patient has mastered moving around the room, they move on to teaching him how to walk with obstacles and up stairs. When descending the stairs, the weaker leg in terms of motor movement should first be lowered and the other one should be placed next to it; the same order is maintained when climbing stairs. Later, when the patient learns to freely lift his legs off the floor and make swinging movements of his legs while supporting himself with his hands on crutches, in a certain sequence he is taught to walk without a corset on a flat surface, then with obstacles, then with one crutch and a stick, with two sticks, with crutches without fastening one knee joint, on crutches without fastening two knee joints and, finally, walking without apparatus with sticks and without sticks. When walking without fastening devices, the patient cannot always do active dorsiflexion of the foot; in such cases, this movement must be carried out using a rubber rod attached to orthopedic boots worn on a special belt.

After completing the inpatient rehabilitation phase, a person who has suffered a spinal cord injury should have their own program for further recovery, implemented under the periodic supervision of the attending physician and a physical therapy specialist.

• In both cases, the reason for the development of a functional technique was the spinal cord injuries received respectively by the athlete V. Krasov during a ski jump and by the aerialist V. Dikul during a rehearsal.

In recent decades, the rhythm of life has changed significantly. Everyone is in a hurry, in a hurry, and this causes them to stumble and fall. This can cause unbearable pain in the back, and as a result, a diagnosis from a doctor who stops the endless rush. What is damage to the spinal column and why is spinal injury dangerous?

General

The human spinal cord is protected reliably. It is closed on all sides by the spine, that is, a strong bone frame, but at the same time it normally receives all the necessary nutrients through a network of blood vessels. Under the influence of various factors, such a stable system can be disrupted. All changes that appear after injury to the spinal cord, nerves, blood vessels and surrounding membranes are known as spinal cord injury.

Spinal pathologies can affect any part of the spinal column: cervical, thoracic, lumbar.

Spinal injuries accompanied by rupture of the spinal cord and damage to its roots are classified as complicated.

Damage factors

The causes that lead to spinal cord damage due to spinal cord injury are varied. Bone fragments that have moved due to a dislocated vertebra can cause damage to the spinal cord and its roots, or spinal cord injuries are caused by a prolapsed intervertebral disc or a hematoma formed at the site of the fracture.

As with the craniocerebral injury, traumatic injury to the spinal cord involves concussion, spinal cord contusion, and compression. The most severe forms of local damage to the spinal cord include its complete anatomical break with the divergence of the ends at the site of the rupture.

Factors leading to spinal cord injuries fall into three categories:

Traumatic

In a road accident, all sorts of damage occurs:

• Fracture.
• Dislocation
• Injury.
• Shake.
• Squeezing.
• Hemorrhage.

Unfortunate fall or fall from a height.

Extreme Sports:

• diving;
• parachuting.

Domestic and work injuries.

Gunshot or knife wound.

Ecological catastrophy.

Pathological

• tumor;
• infectious diseases;
• circulatory disorders.

Congenital - intrauterine and hereditary pathologies.

Classification of injury

In medicine, there are several types of classification of spinal cord injury. Based on the nature of the injury, they are divided into:

1. Closed. The integrity of the soft tissues is preserved.
2. Open:

• there is no penetration into the spinal canal;
• penetrating - tangent, through or blind.

The factors that provoked spinal cord damage play a great role in subsequent therapy.

Spinal cord injuries according to their nature and impact:

• isolated, provoked by point mechanical action;
• combined – together with damage to other tissues and organs;
• combined, which appeared under the influence of wave, toxic and thermal factors.

This classification is based on detailed description damaged tissues, types of injury and characteristic signs. Its system contains the following types of damage:

Injury to supporting and protective components: spinal dislocation, fracture dislocation, vertebral fracture, ligament rupture and spinal contusion.

Damage to nerve components: spinal cord contusion and concussion, contusion.

Compression or squeezing:

• acute - occurs when a vertebra is fractured in the shortest possible time;
• subacute - forms over several days and even weeks;
• chronic - develops over many months, years;
• spinal cord rupture.

Hemorrhage:

• hematomyelia - into the brain tissue;
• between the shells.

Traumatic heart attack or damage to large vessels.

nerve root injury: bruise; pinching; gap

If damage occurs, most often one vertebra is affected, less often two, and injury to three or more is very rare. Which vertebrae are injured? Fractures of the I-II lumbar, V-VI cervical vertebrae and XII thoracic vertebrae are common.

A fracture of the vertebral body often occurs, and compression of the spinal cord occurs if fragments penetrate the lumen of the spinal canal. With a compression injury of the vertebral body, compression occurs with a wedge-shaped bone fragment.

Spinal cord injury can occur during a fracture of the vertebral arches. Even with minimal damage to the spine, severe, irreversible damage to the spinal cord is observed, and with a pronounced injury to the spinal column and if there is a narrowing of the spinal canal, the frequency of severe damage increases significantly.

Symptoms

Signs of a spinal cord contusion or spinal cord injury develop slowly and change over time. Initial manifestations are associated with partial destruction of nerve cells at the time of injury. Subsequent massive destruction can occur due to a number of factors: apoptosis or self-destruction of damaged tissues, deficiency nutrients, oxygen starvation, accumulation of toxic breakdown products.

Due to increasing changes, the course of the disease is divided into periods such as:

• Acute - three days after injury.
• Early - up to one month.

Intermediate - up to 3 months.

• Late - several years after the injury.
• Residual - long-term consequences.

At the initial stage, the symptoms are similar to neurological signs - sensitivity is lost, paralysis occurs. The last stages have symptoms directed towards organic changes - tissue necrosis, degeneration. Exceptions are concussions characterized by fast current, and sluggish chronic diseases.

Factors of occurrence, location and severity of damage have a direct impact on symptoms. Let us take a closer look at the symptoms of various injuries, systematized by sections of the spinal column.

Damage to the spinal cord roots

Cervical region:

• pain in the back of the head, neck and shoulder blades;
• numbness of muscles and skin;
• problems with hand motor skills.

• Pain in the back and between the ribs that increases with movement;
• a stabbing pain in the heart.

Lumbar:

• sciatica in the lower back, buttocks, thighs;
• feeling of weakness and numbness in the limbs;
• sexual dysfunction in men, as well as problems with urinary and bowel control.

Spinal cord contusion

Cervical region:

• swelling in the cervical area;
• loss of sensation in the neck, shoulder girdle, arms;
• weakened motor skills of the neck and arms.

With severe damage, memory weakens, and visual and auditory perception is impaired.

• swelling and numbness appear at the site of injury;
• pain in the back, heart;
• dysfunction of functions: respiratory, digestive; urinary.

Lumbar:

• slight numbness in the area of ​​injury;
• feeling of pain when standing or sitting;
• numbness and atrophy of the lower extremities.

Shake:

Cervical region:

• weakness or mild paralysis of the arms.

• breathing is difficult.

Lumbar

• mild paralysis of the legs;
• problems with urination.

General symptoms boil down to a loss of sensitivity at the site of injury, which manifests itself immediately after injury and can last from several hours to several days.

Squeezing

In the area of ​​injury, signs common to all parts of the spine appear:

• loss of sensation;
• pain syndrome;
• burning sensation;
• paresis;
• spasms;
• paralysis.

Contusion:

• muscle weakness is recurring;
• temporary paralysis;
• reflex disorders.

Signs of spinal shock:

• systemic pathologies – changes in body temperature, excessive sweating;
• disruption of the functioning of internal organs, including the heart;
• hypertension;
• bradycardia.

A few hours after the injury, all of the above symptoms reach their maximum manifestation.

Fracture

Cervical region:

• muscle spasm of the neck;
• turning the head is difficult;
• below the neck, limited mobility and sensitivity of the body has developed;
• paresis;
• paralysis;
• spinal shock.

Pain syndrome:

• in the area of ​​injury;
• encircling;
• in a stomach;
• during movements.

Dysfunction of the body:

• digestion;
• urination;
• loss of sensitivity and motor activity of the lower extremities.

Development of spinal shock.

Dislocation

Cervical region:

• unnatural neck tilt;
• the occurrence of pain at the point of injury, the head;
• weakness;
• dizziness;
• loss of sensation;
• paralysis.

• pain radiating to the intercostal space;
• paraplegia;
• paresis;
• disturbances in the functioning of digestion and breathing.

Lumbar:

• pain radiating to the legs, buttocks, and abdomen;
• paresis or paralysis of the muscles of the lower extremities;
• loss of sensation in the lower body.

Complete rupture of the spinal cord

This pathology is rare and has the following symptoms:

• unbearable pain at the site of injury;
• irreversible absolute loss of sensation and motor activity in the part of the body located below the breaking point.

First aid

Even with the slightest suspicion of spinal cord injury, first aid should be provided with the same caution as in the case of a proven injury. Otherwise, the greatest risk for the victim is vertebral fragments, which, when displaced during movement, can irreversibly damage the spinal cord and the vessels that supply it.

To prevent this from happening, it is necessary to immobilize the victim’s spine. All activities must be carried out only by a group of 5 people acting synchronously and carefully.

The patient should be transferred onto the stretcher smoothly, without unnecessary movements, but quickly, lifting him above the surface just a few centimeters. The stretcher must be placed under it.

The method of immobilization directly depends on the location of the injury. A person with a cervical injury is placed face up on a stretcher, having first secured his neck using:

• a roller in the form of a circle made of soft fabric or cotton wool;
• Elansky or Kendrick tires;
• Shants collar.

Injuries to the thoracic or lumbar regions require transporting the patient on a rigid stretcher or shield. In this case, the person is placed on his stomach, placing a thick cushion under his head and shoulders.

In case of spinal shock, cardiac activity is normalized with the help of atropine or dopamine.

Severe pain is relieved by administering analgesics.

Saline solutions and their derivatives are used for heavy bleeding.

Antibiotics are needed to stop the infection from spreading.

If necessary, to save the life of the victim on the spot, it is allowed to carry out:

• cleaning the oral cavity from foreign bodies;
• artificial ventilation;
• indirect cardiac massage.

After first aid is provided, the victim should be immediately taken to the nearest clinic.

What should not be done when providing first aid:

• transport the patient in a sitting or lying position or without prior immobilization;
• let him get to his feet;
• exert any influence on the site of damage.

Important! Persons without basic medical knowledge can provide only the necessary first aid and only with clear awareness of the manipulations being performed.

Diagnostics

Diagnosis of spinal cord injuries should begin with a history. During the interview, primary neurological signs are revealed:

• physical activity for the first time minutes after injury;
• manifestation of shock;
• paralysis.

In the hospital, a specialist conducts a detailed external examination with palpation. At this stage, the patient’s complaints are taken into account:

• location and strength of pain;
• problems with memory and perception;
• impaired skin sensitivity.

Palpation reveals bone displacement, swelling, unnatural muscle tension and all kinds of deformities. Neurological examination reveals changes in reflexes.

Spinal cord injury requires accurate diagnosis. To do this, an instrumental examination is carried out:

• CT, MRI.
• X-ray of bone tissue in several projections: through the oral cavity, anterior, lateral and oblique.
• Myelography using a contrast agent.
• CT myelography.
• Study of somatosensory evoked potentials. By using this method measure the conductivity of nerve tissue.
• Vertebral angiography is a study of the blood vessels that supply brain tissue.
• Electroneuromyography to assess the condition of muscles and nerve endings.
• Lumbar puncture with liquorodynamic tests to study the composition of the cerebrospinal fluid.

Used on patients with spinal cord injuries, these diagnostic techniques make it possible to distinguish various spinal cord injuries from each other, depending on their severity and cause. These examinations directly influence the choice of therapy.

Treatment

If a spinal cord injury has been confirmed, the specialist draws up a treatment plan. For emergency surgical intervention The following factors are involved in this injury:

• The emergence or increase in neurological symptoms, which is typical for those types of early compression that do not provoke spinal shock.
• Blockage of the cerebrospinal fluid pathways.
• Deformation of the spinal canal by X-ray negative or X-ray positive compression substrates in the presence of corresponding spinal signs.
• Isolated hematomyelia or in combination with blockade of the cerebrospinal fluid pathways.
• Unstable damage to spinal motion segments.

There are also a number of contraindications for surgical treatment of this type of injury:

• Unstable hemodynamics in traumatic or hemorrhagic shock.
• Damage to internal organs associated with this injury.
• Severe traumatic brain injury with impaired consciousness on the Glasgow scale less than 9 points, intracranial hematoma.
• Anemia - less than 85 g/l.
• Cardiovascular, hepatic or renal failure.
• Unfixed limb fractures, fat embolism, pulmonary embolism.

Surgical intervention for compression of the spinal cord should be carried out in a short time, since the first hours account for the majority of all irreversible ischemic changes that occur as a result of compression of the brain and its vessels.

Therefore, all existing contraindications to surgical intervention must be eliminated as soon as possible in the intensive care ward or resuscitation department.

Basic therapy includes:

• normalization of body functions - breathing and cardiovascular activity;
• correction of homeostasis indicators;
• relief of cerebral edema;
• prevention of a number of complications;
• regulation of dysfunction of the pelvic organs using the Monroe system or bladder catheterization at least four times a day;
• introduction of angioprotectors, antihypoxants, cytoprotectors.

If there is damage in the atlanto-occipital zone, the victim needs to undergo reposition as soon as possible. After eliminating this pathology, immobilization is used using a head holder or thoracocranial immobilization.

If the dislocation is complicated by the possible development of cerebral edema, then for the first 6 hours, before the appearance of edema, a one-stage closed reduction of the dislocation should be carried out, followed by external fixation for a period of two months.

If more than six hours have passed after a vertebral spinal injury and the patient has a syndrome of complete impairment of reflex activity of the brain, then he is prescribed open reduction of the dislocation using a posterior approach together with posterior or anterior spinal fusion.

If there is a comminuted fracture of the cervical vertebral body and its compression fracture with an angle deformation of more than 11 degrees, anterior decompression of the brain is performed by removing the broken vertebral bodies, followed by replacement with a graft, implant or cage in combination with or without a titanium plate.

If more than two adjacent vertebrae are injured, anterior or posterior stabilization is performed. If compression of the spinal cord occurs from fragments of a broken vertebral arch from behind, then posterior decompression is necessary. In case of unstable damage to the spinal segment, decompression is combined with posterior spinal fusion, preferably with TFP.

Stable compression fractures of the thoracic vertebrae with a deformation in kyphosis of more than 25 degrees, provoking anterior compression of the spinal cord to the point of flattening and tension on the blade, are treated with immediate closed reclination in the first hours after injury or open reclination and decompression of the brain using inter-spinal fusion with ties or other structures.

Fractured dislocations of the thoracic vertebrae in the acute stage are easy to reduce and reclinate. For this reason, a posterior approach to the spinal canal is used to decompress the brain. After performing such manipulations as I did, external and internal decompression of the brain, local hypothermia, transpedicular spinal fusion is performed, which allows for additional restoration of the spine.

Decompression of the cauda equina roots is performed from the posterior approach, taking into account the large reserve spaces of the lumbar spinal canal. After all the necessary steps, transpedicular spinal fusion of the spinal column and its additional correction are performed. Three weeks later, anterior spinal fusion is performed with autologous bone, a cage, or a special implant.

An anterolateral retroperitoneal approach is used to restore the anterior wall of the spinal canal and replace the removed vertebral body with a bone graft or a special implant. This operation is performed when there is a large deformation of the spinal canal using large fragments of the lumbar vertebral bodies.

Treatment of spinal cord injuries during the rehabilitation period is carried out by several specialists - neurologists, vertebrologists and rehabilitation specialists. Recovery from a spinal injury takes from several months to two years. Regeneration of cells of the spine and spinal cord occurs slowly, and only if a complete transverse lesion of the spinal cord has not occurred. In this case, it is impossible to restore them, and the victim’s life changes forever.

Only a neurosurgeon can select the type of rehabilitation and announce the prognosis after conducting magnetic resonance imaging.

If the cells are restored, rehabilitation of patients is carried out according to a course that includes many factors:

• proper nutrition and adherence to the regime;
• massage and physical therapy;
• also prescription of medications;
• psychological consultation;
• physiotherapy, acupuncture.

When drawing up a rehabilitation course, the specialist assesses the prospects for recovery. The main objective of these activities is to provide the victim with self-care skills. For this purpose, robot-assisted therapy is used.

If the patient has mastered walking with support devices, then the next stage is moving with the help of parallel bars and special shoes.

After discharge from the hospital, restoration of impaired functions continues at home, and walking continues with the use of crutches, walkers, and canes.

Do not delay diagnosis and treatment of the disease!

Make an appointment with a doctor!