The number of wounded with gunshot wounds of the spine during the Great Patriotic War ranged from 1 to 4%. The number of injured in the spine during the fighting in Vietnam, according to published American data, did not exceed 4.6%.
Classification of injuries of the spine and spinal cord
Spinal and spinal cord injuries are divided into 6 groups:
1) penetrating penetrating wounds,
2) penetrating blind wounds,
3) tangential wounds,
4) non-penetrating blind wounds,
5) paravertebral injuries,
6) combined wounds of the spine and other anatomical areas (skull, chest, abdomen, joints, etc.).
Clinic and diagnosis of injuries of the spine and spinal cord
Diagnosis of wounds of the spine and spinal cord is based on a set of local signs and a symptom complex of segmental and conduction disorders of the spinal cord.
Local (absolute) signs of a penetrating wound of the spine and spinal cord are the presence of a wound in the area of a particular spine, leakage of cerebrospinal fluid (cerebrospinal fluid) and brain detritus. A significant help in the diagnosis is provided by comparing the inlet and outlet openings with through penetrating wounds, which makes it possible to judge the direction and length of the wound canal. Segmental and conduction disorders of the spinal cord are manifested in the form of paralysis, loss of various types of sensitivity.
Damage to the diameter of the spinal cord causes dysfunction of the lower extremities or (with high injuries) tetraplegia with loss of all types of sensitivity downward from the level of damage, at the same time there are dysfunctions of the pelvic organs (urination, bowel movements). Correspondingly to affected segments, segmental disorders occur downward from the focus – conduction. The severity of a spinal injury is determined by the level of damage to the spinal cord, as well as the degree of damage to the diameter of the spinal cord (damage to the posterior column, anterior column, lateral column, half or complete damage to the diameter of the spinal cord). In the clinical course of gunshot wounds of the spine and spinal cord, 4 periods are distinguished. A. Acute period – the first 2-3 days after injury: a syndrome of complete impaired conduction of the spinal cord due to an anatomical break or spinal shock is expressed. B. The early period is 2-3 weeks after being wounded; like the acute period, it is characterized by persistent neurological disorders.
The degree of damage to the spinal cord cannot be detected due to spinal shock and a disorder of blood and cerebrospinal circulation . 3-4 weeks after the injury, the upper level of sensory impairment begins to decline and the topic of the main focus of brain damage is determined. Infectious complications arise: meningitis, uroinfection (cystitis, pyelitis, urosepsis ), trophic disorders (pressure sores). B. Intermediate period – the next 2-3 months. The processes of cleansing the wound and organizing productive arachnoiditis and cysts, as well as the development of scars in the epidurial tissue after pachymeningitis and hemorrhages are nearing completion .
At the beginning of this period, the phenomena of spinal shock are eliminated, and by the end of 3-4 weeks you can determine the true size and nature of the lesions of the brain substance. With a successful course of the wound process, the general condition of the wounded improves. Under adverse conditions, infectious complications and trophic disorders end with wound cachexia. Wound osteomyelitis may occur. G. Late period – begins from 3-4 months after the injury and lasts 2-3 years or more. The decay products of myelin and hemorrhages are resolved, the wounds of the spinal cord heal, and a brain scar or cavity is organized. With a favorable course, spinal cord function is slowly and progressively restored. Automatism of the spinal cord regions located below the lesion level is restored . Often late post-traumatic complications develop – scar adhesions (pachymeningitis, arachnoiditis, meningoradiculitis ).