Fractures of the spine, complicated by damage to the spinal cord and its structures – roots and membranes, are observed quite often (in 40-70% of cases). Especially often, spinal cord injuries occur during fracture- dislocation of the spine.
Symptoms of Complicated Spinal Fractures
The symptomatology of neurological changes is extremely diverse and depends on the varying degree of damage and involvement in the sphere of trauma of the spinal cord and its formations: membranes, roots, spinal cord matter.
In the pathological anatomical relation, hemorrhages in the membranes ( epidural , subdural , subarachnoidal), hematomyelia, compression of the spinal cord, its partial or complete destruction can be observed . At the level of the cauda equina there are hemorrhages in the root area, their compression, partial or complete rupture, often there is the formation of secondary subarachnoid cysts, which cause root irritation.
With a more or less significant spinal cord injury, a number of characteristic symptoms are clinically observed: motor and sensitive paralysis, disorders of the pelvic organs with delayed urination and defecation, disturbances in normal reflex activity and a number of trophic disorders in the form of pressure sores, swelling of the extremities, etc. In the first hours and days after injury, patients develop a picture of general and spinal shock.
Complete symmetric motor and sensory paralysis, dysfunction of the pelvic organs with rapidly developing urinary tract infections (cystitis, ascending pyelonephritis), progressive pressure sores and diffuse swelling of the lower extremities indicate more significant damage to the spinal cord, which is often irreversible. In such cases, usually the patient’s condition worsens and death occurs. On the contrary, a change in the state of motor or sensory paralysis, restoration of the mobility of any segment of the limb, a decrease in the zone of anesthesia and a number of other symptoms indicate the possibility of a more favorable outcome. In particular, such dynamics of paresis and paralysis is observed with gradual resorption of hemorrhages in the dural sac.
In case of damage to the cervical segments of the spinal cord, paresis and paralysis of the upper extremities with corresponding sensitivity disorders are characteristic.