Classification of damage to the spine and spinal cord
All closed injuries of the spine and spinal cord are divided into 3 main groups.
1. Uncomplicated spinal injuries (subluxations and vertebral fractures without spinal cord injury). 2. Dislocations, fractures and fractures with damage to the spinal cord. 3. Damage to the spinal cord without pronounced bone changes. Closed trauma of the lower brain can be without bone damage and can be manifested in the form of: a – concussion of the lower brain, b – bruise, c – hematoma compression, d – hemorrhage in the brain substance. Depending on the localization, spine fractures are distinguished: cervical, thoracic, lumbar, sacral. By the type of vertebral fractures they are distinguished: linear, compression, comminuted . Depending on the displacement of the vertebral bodies, they will distinguish: dislocations and subluxations, as well as fractures . In addition, there may be combined injuries of the spine: injuries of the spine and head injury, injuries of the spine and chest or abdomen, spinal injuries and fractures of the pelvis or limbs.
Clinic and diagnosis of spinal cord and spinal cord injuries
Symptoms of a closed spinal cord injury are manifested by segmental disorders, conduction disturbances and radicular changes.
Segmental disorders: girdle or shooting radicular pain (causalgia) at the level of spinal cord injury. Segmental disorders arise as a result of damage to the gray matter of the spinal cord: motor , sensitive, associative cells, as well as cells of the cerebellar proprioreceptors, cells of the sympathetic and parasympathetic spinal centers (segmental apparatus).
Conduction disorders (paresis, turning into paralysis, pyramidal pathological signs of hypesthesia, anesthesia, urinary retention, various types of sensory disturbances, the appearance of pathological symptoms ( Kernig , Brudzinsky , etc.), etc.) result from damage to the conductor apparatus – white matter spinal cord:
anterior posts, posterior posts, side posts with damage to the ascending and descending paths. In contrast to segmental disorders, conduction apparatus lesions are more diffuse . Like segmental disorders, conduction can be functional and organic.
Various symptom-complex lesions of the spinal cord occur depending on the level of damage .
Upper cervical spine
In case of damage to the upper cervical region (CI-CIV), paralysis or irritation of the diaphragm (shortness of breath, hiccups), spastic paralysis: of all four, limbs, loss of all types of sensation from the appropriate level downward, central type urination disorders (delay, periodic urinary incontinence) occurs ), as well as disorders of the function of the rectum and its sphincters, usually accompanying them. There may be radicular pain in the neck, extending to the back of the head. And when involved in the process of the stem parts of the brain – disorders of swallowing, breathing, etc.
Cervical thickening (CV-D1) – peripheral paralysis of the upper limbs, spastic paralysis of the lower limbs, loss of all types of sensation and urination disorders, as well as the function of the sphincter of the rectum. Persistent constipation. Root pains radiating to the upper limbs are possible. Often joined Horner’s syndrome; ( Horner ) (narrowing of the pupil, reduction of the palpebral fissure and retraction of the eyeball).
Thoracic region (DI-DXII) – the upper limbs are not affected; spastic paraplegia of the lower extremities G is observed with the same disorders of urination and: defecation; loss of all kinds of sensation in the lower half of the body. Radicular pains are shingles.
Lumbar thickening (LI-SII) – peripheral paralysis of the lower extremities, lack of sensitivity on the lower extremities in the perineum, the same disorders of the pelvic sphincters. Flaccid paralysis of the sphincter of the rectum, fecal incontinence.
Gonus medullaris (( Sin-Sv ) – no paralysis, loss of sensation in the perineum, peripheral-type urination disorders (usually true urinary incontinence). Impairment of the function of the sphincter of the rectum, expressed by fecal incontinence.
Horse tail ( cauda eguina ) – its defeat gives a symptom complex , very similar to the defeat of the level of LI-SII and conus medullaris . There is peripheral paralysis of the lower extremities with disorders of urination such as delay or true incontinence, lack of sensitivity on the lower extremities and in the perineum. Severe radicular pain in the legs is characteristic, and with partial and incomplete injuries – asymmetry of symptoms
True (“clean”) closed spinal cord injuries
Shaking – manifested by weakness in the legs, decreased sensitivity, difficulty urinating, etc. These phenomena quickly pass. The bruise is characterized by severe disorders of the spinal cord, up to the syndrome of lateral conduction disturbance in the form of paralysis and loss of sensitivity below the level of damage, urinary retention and defecation. Bruising of the spinal cord is accompanied by hemorrhage, swelling and softening of certain parts of the spinal cord. Spinal cord compression (compression) usually occurs as a result of hemorrhage ( epidural or subdural hematoma). Epidural hematoma is manifested by girdle or shooting radicular pain as a result of compression of the spinal cord. Subsequently, conduction disturbances develop – paresis, turning into paralysis, hypesthesia, anesthesia, urinary retention and violation of the bowel movement. Subarachnoid hemorrhage gives a picture of the irritation of the meninges – meningial symptoms of Kernig , Brudzinsky and others. With lumbar puncture in punctate – blood. Subdural hematoma is characterized by a slow increase in the phenomena of compression of the spinal cord. With lumbar puncture, a block of subarachnoid space and an admixture of blood in the cerebrospinal fluid are determined. Hemorrhage in the spinal cord (hematomyelia) with closed spinal injuries occurs most often in the gray matter, affecting the horn horns and commissure, the posterior columns of the spinal cord. Localization of hematomyelia – cervical or lumbar thickening of the spinal cord, as well as the cone of the spinal cord. Clinically, hemorrhage in the spinal cord is manifested by the acute development of spinal cord conduction disorders (segmental and conduction disorders), paralysis and dissociated sensitivity disorders – loss of pain and temperature sensitivity while maintaining tactile. Paralysis and complete anesthesia are noted below the level of hemorrhage. With hemorrhage in the sacral part of the spinal cord, paradoxical urinary incontinence ( ischuria paradoxa ) is observed . With lumbar puncture, the block of subarachnoid space is absent.