Spinal fracture with spinal cord treatment. All about the injuries of the spinal cord - what are there and how to treat them

The spinal cord is located in the spinal canal and is responsible for the work of the digestive, respiratory, reproductive, urinary and other major systems of the body. Any violations and damage to the spine and nervous tissue are fraught with violations in organs and other pathological phenomena.

Damage to the spinal cord doctors consider stretching, squeezing, injury with intracerebral hemorrhage, breaks or separation of one or several nerve roots, as well as infectious damage and developmental anomalies. In the article, we will look at the symptoms, diagnosis and treatment of spine and spinal cord injuries. You will learn how help is performed on a chipboard and transportation of a spinal cord injured in injuries.

Disorders in the work of the spinal cord cause both independent diseases and the injuries of the spine. The reasons for the damage to the spinal cord are divided into 2 large groups: traumatic and non-immoral.

Traumatic belongs to the following reasons:

Non-mass causes of spinal cord damage:

• inflammatory processes: myelitis (viral or autoimmune);
• tumors: sarcoma, lipoma, lymphoma, gyoma;
• radiation myelopathy;
• vascular spinal syndromes, vessel compression;
• myelopathy associated with violation of metabolism;
• purulent or bacterial infection: tuberculous, mycotic spondylitis;
• chronic rheumatic spine pathology: rheumatoid, reactive arthritis, illness;
• degenerative changes of the spine: osteoporosis, spinal canal stenosis ,.

Types of injury

Damage to the spinal cord is classified on various bases. There are open injuries with damage to soft tissues and skin and closed injuries without external damage.

Types of spinal injuries:

• stretching or breaking sprouts of the spine;
• fractures of the vertebrae: compression, assholes, edges, explosive, vertical and horizontal;
• intervertebral disks;
• dislocations, sublits, fractures;
• spondylolisthesis or vertebrae offset.

Types of spinal cord damage:

• injury;
• squeezing;
• partial or complete gap.

Ears and squeezing are usually associated with a spinal injury: dislocation or fracture. When injected, the integrity of the spinal tissue is disturbed, hemorrhage and brain tissue swelling are observed, the scale of which will depend on the degree of damage.

Sumpring occurs when fractures of the bodies of the vertebrae. It is partial or complete. Squeezing is often found in divers; Most often damage bottom cervical vertebrae.

Atrophic paralysis of the hands, paralysis of the legs, develops atrophic paralysis of the legs, decreases the sensitivity in the area below the lesion level, there are problems with the pelvic authorities and there are straggings in the zone of the sacrum.

Squeezing in the region of the lumbosacral spine leads to paralysis of the legs, loss of sensitivity and dysfunction of pelvic organs.

Symptoms

Signs of damage to the spinal cord depends on the type of injury and the place where it happened.

General signs of spinal cord problems:

Damage to the spinal cord in newborns most often happens in the cervical or lumbar departments. The fact is that the spinal cord in the kid in comparison with the spine and ligaments less stretchable and in injuries is easily damaged without visible changes in the spine itself.

In some situations, even a complete gap of the spinal cord occurs, although no changes will be visible on the x-ray.

Due to damage to the neck during childbirth, the child will be in a state of anxiety. The neck can be twisted, lengthen or shorten. The infant has the same symptoms as in adults: spinal shock, swelling, breathing problems, violations in the work of internal organs, muscle atrophy, reflex and motor disorders.

First aid

The consequences of injuries will be dangerous if you correctly provide first aid. The victim is placed smoothly on a rigid surface and transported on a hard shield. If you do not carry out immobilization, bone fragments and fragments will continue to squeeze the spinal cord, which is fraught with a fatal outcome.

The injured is transferred solely on the rigid surface. In case of suspected damage to the cervical head, the head is additionally fixed using a tire from the tires (rollers from the fabric).

Attention! You can not sit down or try to raise the victim's feet. It is required to keep track of breathing and pulse and, if necessary, carry out resuscitation activities.

Main rules:

1. Limit the movement of the victim, place it on a solid surface and fix the damaged area with the help of remedies.
2. If necessary, give an analgesic.
3. Watch that the victim is conscious.

In a severe injury situation, the spinal cord is disconnected for some time, a shock state occurs. The spinal shock is accompanied by a disorder of the sensory, motor and reflex functions of the spinal cord.

Violation applies below the level of damage. During this period, it is impossible to identify any reflex, only the heart and lungs work. They function offline, other organs and muscles also do not work.

During the waiting period, while the shock and the spinal cord goes into operation, the muscles are maintained using electrical impulses to prevent atrophy.

Diagnostics

How to check the spinal cord in a person after injury? To determine the level of damage, X-ray (minimum in 2 planes) is carried out.

Computer and magnetic resonance tomography Give the most detailed picture of the state of the spine and the spinal cord. Here you can see the spinal cord both in the longitudinal and in cross section, to identify hernias, fragments, hemorrhages, damage to nerve roots and tumors.

Mielography It is carried out in order to diagnose nerve endings.

Vertebrian angiography Shows the condition of blood vessels of the spine.

Lumbal puncture It is done to analyze the spinal fluid, detecting infection, blood or foreign bodies in the spinal channel.

Treatment methods

The treatment of the spinal cord depends on the severity of its damage. In case of damage to an easy degree, the victim is prescribed a bed regime, the reception of painkillers, anti-inflammatory and general fascinating agents.

In the event of a violation of the integrity of the spine, compresses the spinal channel and the presence of severe damage is necessary operation. It is made to restore damaged spinal tissues and spinal cord.

In case of serious damage, an emergency operation is necessary. If you do not help the victim in time, 6-8 hours after injury may occur irreversible consequences.

In the postoperative period, intensive therapy is carried out to prevent side effects. In this process, the work of the heart system, respiration is restored, the brain swelling is eliminated and the prevention of infectious lesions is carried out.

Orthopedic

Orthopedic treatment Includes refueling dislocation, fractures, stretching and prolonged immobilization of the spine. The patient is recommended to wear a cervical collar during damage to the cervical spine or orthopedic corset in the treatment of thoracic or lumbar departments.

Conservative treatment implies the use of the method of stretching the spine. If the chest and lumbar spine is damaged, the stretch is carried out with the help of loops by hanging the patient for the axillary depressures.

Also used beds with raised headboard. In the treatment of the cervical deposition, the glisson loop is used. This is a fixture in the form of a loop where the head is mounted with a cable and counterweight. Due to the counterweight and gradually stretching.

Medical therapy Includes the reception of anti-inflammatory and painkillers. Preparations are prescribed for the restoration of blood circulation, strengthening the body and intensify the processes of tissue regeneration.

If the victim has a spoonful shock, dopamine, atropine and significant doses of methylprednisolone are used. With the pathological stiffness of the muscles, the muscle relaxants of the central action () are prescribed. To prevent the development of inflammatory phenomena, antibiotics of a wide range of action are taken.

Rehabilitation

Rehabilitation period takes up to several months. After restoring the integrity of the spinal cord, workouts begin to restore physical activity.

Therapeutic workouts of the first week begin with breathing exercises. In the second week, turn on their hands and legs. Gradually, depending on the state of the patient, the exercises complicate, translate the body into a vertical position from the horizontal, increase the volume of movements and load.

As they recovers, the rehabilitation process includes massages.

Physical church It is carried out to restore motor activity, preventing the prevention and disorders of the pelvic organs. It contributes to the regeneration of tissues in the field of injury and lymphaticine, improves blood supply, cellular and tissue metabolism, reduces swelling and inflammatory processes.

Ultrasound, magnetic therapy, general ultraviolet irradiation, electrophoresis with lidase and novocaine, phonoforesis are used for treatment.

Reference. Physiosparces in combination with drugs improve the nutrition and the absorption of active substances in tissues and cells.

With paralysis and lines of lower extremities, hydrolyvanic baths are used, massage shower under water, mud appliqués. Mudshell can be replaced with ozkerite or paraffin.

With pain syndrome, balneotherapy, rodon and coniferous baths, as well as vibration and vortex baths are used.

Along with therapeutic physical education, hydrocenesiotherapy is used, swimming in the pool.

Complications during the injury of the spinal cord

Complications come:

• with untimely rendered medical care;
• in case of violations of patients, the discipline of treatment and rehabilitation;
• in case of neglecting the recommendations of the doctor;
• as a result of the development of infectious and inflammatory side processes.

From light bruise, local hemorrhage in the tissues of the spinal cord, squeezing or shaking serious consequences does not occur, the victim fully recovers.

In severe cases - with extensive bleeding, spinal fractures, strong bruises and squeezing - splashes, cystitis, pyelonephritis appear.

If pathology takes a chronic form, paresis develops, paralysis. In case of an unfavorable outcome, a person completely loses the motor functions. For such patients, constant care is required.

Conclusion

Any damage to the spinal cord is fraught with serious problems. Incompretation, dismissive attitude to the state of its spine and medical recommendations can lead to deplorable results.

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Closed damage to the spine and spinal corddivided into three groups:

1) damage to the spine without disturbing the function of the spinal cord;

2) damage to the spine, accompanied by a violation of the conductivity function of the spinal cord;

3) closed damage to the spinal cord without damaging the spine.

Damage to the spine are found in the form of fractures of bodies, the arms, processes; dislocations, fracture dislocations; breaks of the ligament, damage to intervertebral discs. The damage to the spinal cord can be in the form of a brain compression and its roots with epidural hematoma or bone frails, concussion or injury of the brainstant, breaking the spinal cord and its roots, subarachnoid hemorrhage and hemorrhage in the brainstanty (hematomyiel).

The spinal brain injury is characterized by a violation of the function of conductive paths and is manifested by paralysis and loss of sensitivity below the level of damage, urination delay and defecation. All phenomena are developing immediately after injury and are held within 3-4 weeks. In this period, pneumonia, breakdowns, ascending cystopyelonephritis and UROSPSIS can develop.

Spinal cord compression can be sharp (comes at the time of injury) early (after hours or days after injury) and late (months later or years after injury).

Localization compresses distinguish: rear (with a broken vertebra, epidural hematoma, torn in yellow ligament), front (body of a broken or displaced vertebra who fell out intervertebral disk), domestic (brain swelling, intracerebral hematoma, detritus in a softening center).

Compression can be with a complete violation of passability Likvoreupported ways and spinal cord functions, with partial violation of passability liquor-conducting pathways, and by the nature of the development - sharply progressive and chronic.

The diagnosis of the spinal cord compression syndrome is based on the data of neurological inspection, overview spondylograms and special research methods, including an assessment of the sub-barnoidal space for liking puncture with the conduct of liquorodynamic samples, positive myelography with water-soluble contrasting substances or pneumomyelography. The compression syndrome of the spinal cord is characterized by a block of subarachnoid space, increasing neurological disorders. Especially dangerous swelling at the injury of the cervical spinal cord.

When sining the spinal cord, the rear structures of the vertebrae are applied decompressive laminectomy 2-3 studies. The timing of it with the closed injuries of the spine:

• emergency Laminectomy - for the first 48 hours after injury;
• early Laminectomy is the first week after injury;
• late Laminectomy - 2-4th weeks.

When squeezing the front spinal cord structures shifted into the lumen of the spine canal, bone fragments, damaged intervertebral discs, an operation is used - the front decompression of the spinal cord (removal of bone fragments and destroyed intervertebral disks with front access) with the subsequent front corporal bone autotransplant.

The fractures of the vertebrae without damage to the spinal cord are treated either conservatively: lumbar and thoracic departments - stretching straps over the axillary areas on the bed with a shield, using rollers to reposition of vertebrae in bed; The cervical departure is a skeletal depression for dark bugs and bones, or promptly, in order to restore the configuration of the spine channel and stabilize the spine: the vertebral reposition is performed, the removal of bone fragments and the fixation of the spine with metal structures.

With the injuries of the spinal cord without damaging the spine, conservative treatment is carried out.

Firearfings of the spine and spinal cord are divided:

• by the form of a wounding projectile - on bullet and fragmentation;
• by the nature of the wound channel - on end-to-end, blind, tangents;
• in relation to the vertebral channel - to penetrate, impermeal, paravertebral;
• in terms of level - on the cervical, chest, lumbar, sacral divisions; Almedy isolated, combined (with damage to other organs), multiple and combined injuries.

Penetrating injuries of the spine call damage under which the bone spinal channel ring and a solid brain shell are destroyed.

In the acute period of damage to the spinal cord, the spinal shock develops, manifested by the oppression of all the functions of the spinal cord below the place of damage. At the same time, tendon reflexes are lost, muscle tone decreases, the sensitivity, the function of the pelvic organs (by type of acute delay) is disturbed. The state of the spinal shock lasts 2-4 weeks and is supported by the foci of spinal cord irritation: foreign bodies (metal fragments, bone fragments, ligament scraps), sites of traumatic and circular necrosis.

The heavier injury of the spinal cord, the later restoring its reflex activity. When evaluating the degree of damage to the spinal cord, the following clinical syndromes distinguish:

Syndrome of full transverse destruction of the spinal cord; It is characterized by tetra and paraplegia, tetra and paralysthesia, a violation of the function of pelvic organs, the progressive development of bedding, hemorrhagic cystitis, quickly coming cachexia, swelling of the lower extremities;

Syndrome of partial damage to the spinal cord - in the acute period is characterized by the different severity of symptoms - from the preservation of movement in the limbs with a slight difference in reflexes, up to paralysis with a violation of the function of the pelvic organs. The upper limit of sensitivity disorders is usually unstable and may change depending on the circulatory disorders, brain edema, etc.;

The spinal cord compression syndrome for gunshot wounds - in the early period, it occurs most often due to the pressure on the brain substance by a wounded shell, bone frails, displaced vertebrae, as well as due to the formation of subdural and epidural hematomas;

The perioreural root position syndrome is observed at the blind injection of the spine in the area of \u200b\u200bthe horse-tail with the subdural location of the foreign body. The syndrome is expressed by a combination of pain and bubble disorders: in the vertical position of the crotch pain intensify, and the emptying of the bladder is more difficult than in the lying position.

Damage to the upright spine and spinal cord department is characterized by a severe condition with a pronounced respiratory impairment (due to the paralysis of the muscles of the neck and the chest wall). Often such damage is accompanied by stem symptoms: loss of consciousness, swallowing disorder and violations of the activity of the cardiovascular system due to the rising edema.

Damage to the bottom of the spine is accompanied by respiratory disorder, high paralysis (tetraplegia), sensitivity disorders below the level of the clavicle and often the symptom of the city (narrowing the pupil, the eye slit and some of the eyeball of the eyeball).

In case of damage to the thoracic spinal cord, the paraplegium of the lower extremities is developing, violation of the pelvic organ function and the sensitivity disorder from the lesion level (the fifth breast segment corresponds to the level of nipples, the seventh-rib arc, the tenth-lines of the navel layout, twelfth - inguinal folds). Damage to the lumbar spinal cord, the segments of which are located at the level I x-xi of breast vertebrae, is accompanied by a paraplegium, a violation of the function of the pelvic organs (by type of incontinence) and the sensitivity disorder of the book from the inguinal folds.

With the defeat of the epicus and the roots of the initial suspension of the horse-tail, the sluggish muscle paralysis of the legs, stop, buttocks, and sensitivity disorders are determined on the skin of the lower extremities and in the crotch area.

Wounds of the lower-friendly and sacral spinal sections are accompanied by damage to horse-tail roots and clinically characterized by sluggish paralysis of the lower extremities, root pain and urinary incontinence.

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Spine injuries: prevalence, reasons and consequences

Prevalence of injuries of the spine

According to various authors, damage to the spine range from 2 to 12% of cases of traumatic lesions of the musculoskeletal system.
The average portrait of the victim: a man under 45 years old. In old age spine injuries With the same frequency, both men and women are observed.

The forecast for the injuries of the spine, combined with damage to the spinal cord, is always very serious. Disabled in such cases is 80-95% (by different sources). A third of patients with spinal cord injuries perishes.

Especially dangerous damage to the spinal cord in injuries of the cervical spine. Often such victims are dying at the scene of the incident from stopping the breath and blood circulation. The death of patients in a more distant period after injury is caused by hypostatic pneumonia due to impaired ventilation of the lungs, urological problems and breakdowns with the transition to the septic state (blood infection).

Damage to the spinal column and the spinal cord in children, including the generic injury of the spine, is better to treat and restorative rehabilitation due to the large adaptation capabilities of the children's body.

It should be noted that the consequences of the spinal injuries are largely determined by the time interval from damage before the start of comprehensive treatment. In addition, very often unpleasant rendered to the first help greatly aggravates the state of the victim.

Treatment of spinal injuries - complex and long-term, often the participation of several specialists (traumatologist, neurosurgeon, rehabilitologist). Therefore, in many countries, patients with serious damage to the spinal column are concentrated in specialized centers.

Anatomical structure of the spine and spinal cord

Anatomy of the spinal column

The spine consists of 31-34 vertebrae. Of these, 24 vertebra are combined free (seven cervical, twelve chest and five lumbar), and the rest have grown into two bones: the crushes and the tail rudiment in humans - the tailbone.

Each vertebral consists of a swayed body and arc, which restricts the vertebral hole behind the vertebral hole. Free vertebrae, with the exception of the first two, have seven processions: oste, transverse (2), upper joints (2) and lower joints (2).
The articular processes of neighboring free vertebrae are connected in the joints that have durable capsules, so that the vertebral pole is an elastic rolling connection.

The vertebral bodies are connected into a single integer with elastic fibrous discs. Each disk consists of a fibrous ring, inside of which a pulp nucleus is located. This design:
1) ensures the mobility of the spine;
2) depreciates concussion and load;
3) Stabilizes the vertebral pole as a whole.

Intervertebral disc is deprived of blood vessels, nutrients and oxygen come by diffusion from adjacent vertebrae. Therefore, all regenerative processes occur here too slowly, so that a degenerative disease is developing with age - osteochondrosis.

Additionally, the vertebrae is connected by bundles: longitudinal - front and rear, inter-chain or "yellow", inter-soul and supervisory.

The first (Atlant) and the second (axial) cervical vertebrae are not like the rest. They were modified as a result of human straightening and provide a head connection with a spinal column.

Atlant does not have a body, but consists of a pair of massive lateral surfaces and two arms with upper and lower joint surfaces. The upper joint surfaces are articulated with the soils of the occipital bone and provide bending-extension of the head, and the lower facing the axial vertebra.

A transverse bundle is stretched between the side surfaces of the Atlanta, in front of which the obliged brain is located, and the forge of the axial vertebrae, called the tooth. The head, together with the Atlant, rotates around the tooth, and the maximum of the angle of rotation in any direction reaches 90 degrees.

The anatomy of the spinal cord

The spinal cord located inside the spinal column is covered with three shells, which are a continuation of the shells of the brain: solid, web-shaped and soft. The book he is narrowing, forming a brain cone, which at the level of the second lumbar vertebra goes into the terminal thread, surrounded by the roots of the lower spinal nerves (this beam is called a horse-tail).

Normally between the spinal canal and its contents are the backup space, allowing you to painlessly transfer the natural movements of the spine and minor traumatic vertebrae displacements.

The spinal cord in the cervical and lumbar-sacrive departments has two thickening, which are caused by the accumulation of nerve cells for the innervation of the upper and lower extremities.

Breakfasts the spinal cord with their own arteries (one front and two rear spinal), sending small branches in the depth of the substance of the brain. It is established that individual sections are supplied immediately from several branches, while others have only one supplying branch. This network focuses the root arteries, which are variable, and in some segments are absent; At the same time, sometimes one root artery nourishes several segments at once.

With a deforming injury, the blood vessels are driving, squeezed, separately, their inner liner is often damaged, as a result of which thrombosis is formed, which leads to secondary circulatory disorders.

It is clinically proven that the damage to the spinal cord is often associated with a direct traumatic factor (mechanical injury, compression of vertebral fragments, etc.), but with blood violations. Moreover, in some cases, due to the characteristics of blood circulation, the secondary lesions can capture sufficiently large areas outside the action of the traumatizing factor.

Therefore, in the treatment of spinal injuries complicated by the damage to the spinal cord, the speeding of deformation and the restoration of normal blood supply was shown.

Classification of injuries of the spine

The spinal injuries are divided into closed (without damage to the skin and tissues covering the vertebral) and open (firearms, bone bayonet wounds, etc.).
Topographically distinguished injuries of different spinal departments: cervical, chest and lumbar.

By the nature of the damage allocate:

• bruises;
• distortions (oversights or bundles of bundles and vertebral joints without displacement);
• fractures of ostic processes;
• fractures of transverse processes;
• fractures of vertebral arcs;
• fractures of vertebral bodies;
• subways and dislocations of the vertebrae;
• fracture-dislocations of the vertebrals;
• traumatic spondylolisthesis (gradual displacement of the verteons of Kepesed due to the destruction of the ligament.

In addition, a large clinical significance is distinguished by stable and unstable injuries.
Unstable injury of the spine - a condition in which the deformation that occurred as a result of injury may be aggravated.

Unstable injuries occur when combined damage to the rear and front spoken departments, which is often found in the bent-rotational mechanism of injury. Unstable injuries include dislocations, subluxers, fracture-dislocations, spondylolisthesis, as well as injuries from shear and stretching.

Clinically important is the separation of all the injuries of the spine to uncomplicated (without damage to the spinal cord) and complicated.

There is a next classification of spinal cord injuries:
1. Reversible functional disorders (concussion).
2. Irreversible damage (injury or contusion).
3. The sinth syndrome of the spinal cord (can be caused by fragments and fragments of vertebrae parts, fragments of bundles, pulp nucleus, hematoma, edema and swelling of fabrics, as well as several of the listed factors).

Symptoms of the injury of the spine

Symptoms of stable spinal injuries

The stable injury to the spine includes injury, distortion (breaking ligaments without displacement), fractures of ostic and transverse processes, whip damage.

When the spine injury, the victims complain about spilled soreness at the injury. During the inspection, swelling and hemorrhage, movements are limited slightly.
Distortion occurs, as a rule, with a sharp lift of weights. It is characterized by an acute pain, a sharp limitation of movements, pain in pressing for octic and transverse processes. Sometimes the phenomena of the radiculitis are joined.

Fractures of ostic processes are diagnosed not often. They arise both as a result of a direct application of force and due to a strong reduction in muscles. The main signs of fractures of octic processes: sharp pain in palpation, sometimes you can adversely forgive the mobility of the damaged process.

Fractures of transverse processes are caused by the same reasons, but more often occur.
They are characterized by the following symptoms:
Pyra Symptom: Localized soreness in the paravertebral area, increasing when turning in the opposite direction.

Symptom of stuck heel: When the patient's back position, it cannot tear off the straightened leg from the bed on the side of the lesion.

In addition, there is a spilled soreness in the place of damage, sometimes accompanied by the occurrence symptoms of radiculitis.

The neck injuries, characteristic of intra-automotive incidents, are usually as a rule, to stable spine injuries. However, quite often they have severe neurological symptoms. The damage to the spinal cord is caused by both direct contusions during damage and circulatory disorders.

The degree of lesion depends on age. In the elderly, due to age-related changes of the spinal canal (osteophytes, osteochondrosis), the spinal cord is stronger.

Signs of injuries of the medium and lower spine

Injuries of the medium and lower vertebrae are found in road catastrophes (60%), jump into water (12%) and drops from a height (28%). Currently, the injuries of these departments amount to 30% of all the damage to the spine, one third of them proceeds with spinal cord lesions.

Dislocation, subsidiaries and fractures - dislocations are quite often in view of the special mobility of the bottom of the spine, and are classified on tilting and sliding. For the first characteristic of the pronounced kyphosis (overlapping of the seat) and the expansion of the interacement gap due to the breaking of the supervisory, inter-sighted, inter-wantry and rear longitudinal ligaments. With sliding damage, there is a binary deformation of the spine, fractures of the articular processes. The victims are disturbing the strong pain and the forced position of the neck (the patient supports his head with his hands). Often there are injuries of the spinal cord, the severity of which largely determines the forecast.

Isolated fractures of the third-seventh cervical vertebrae are diagnosed rarely. Characteristic feature: pain in the damaged vertebral with a dynamic load on the patient's head (pressed on the top).

Symptoms of injuries of the chest and lumbar spine

For injuries of the chest and lumbar spine, fractures and fractures are characterized; Isolated dislocations are found only in the lumbar department, and it is extremely rare, due to limited mobility.

There are many classifications of damage to the chest and lumbar spine, but they are all complex and cumbersome. The most simple clinical.

According to the degree of damage, which depends on the value of the applied force, directed at an angle to the axis of the spine, is distinguished:

• wedge-shaped fractures (the body of the vertebral body is damaged and part of the substance, so that the vertebra takes a wedge-shaped form; such fractures are mainly stable and subject to conservative treatment);
• wedge-shaped-owls (the whole body of the vertebral body is damaged and the upper circuit plastic is damaged, so the process affects the intervertebral disc; injury is unstable, and in some cases requires surgery; may be complicated by the damage of the spinal cord);
• fracture-dislocation (the destruction of the body of the vertebral, multiple damage to the ligament apparatus, the destruction of the fibrous ring of the intervertebral disk; injury is unstable, and requires immediate surgery; as a rule, such lesions are complicated by damage to the spinal cord).

Separately, the compression fractures arising due to the load along the spine axis (when the compression fractures fall on the feet appear in Nizhnegorudna and lumbar departments, when falling on the head - in Uppergrudny). With such fractures in the body, the vertebra is formed a vertical crack. The severity of the lesion and tactics of treatment will depend on the degree of divergence of fragments.

Fractures and fracture-dislocations of the chest and lumbar departments have the following symptoms: enhancing pain in the zone of the fracture at dynamic load along the axis, as well as when tapping on withcending processes. The protective tension of the straight muscles of the back (muscle rollers located on the sides of the spine) and the abdomen are expressed. The latter circumstance requires differential diagnosis with damage to the internal organs.

Signs of damage to the spinal cord

Motor disorders

Motor disorders during the damage to the spinal cord, as a rule, are symmetrical. Exceptions make up the corpus wounds and damage to the horse tail.

Heavy spinal cord lesions lead to the absence of movements in the limbs immediately after injury. The first signs of recovery of active movements in such cases can be detected no earlier than in a month.

Motor disorders depend on the level of lesion. Critical level is the fourth cervical vertebra. The diaphragm paralysis, developing under the lesions of the upper and medium-sized spinal cord sites, leads to the respiratory stop and the patient's death. Damage to the spinal cord in the lower and chest segments leads to paralysis of intercostal muscles and respiratory disorders.

Sensitivity disorders

Damage to the spinal cord is characterized by violation of all types of sensitivity. These violations have both quantitative (reduction of sensitivity up to complete anesthesia) and a qualitative character (numbness, a sense of crawling goosebumps, etc.).

The degree of severity, the nature and topography of the sensitivity impairment is of an important diagnostic value, because it indicates the place and severity of the injury of the spinal cord.

It is necessary to pay attention to the dynamics of violations. The gradual increase in signs of sensitivity and motor disorders is characteristic of a spinal cord with bone fragments, fragments of bundles, a hematoma shifting the vertebra, as well as to disrupt blood circulation due to the compression of the vessels. Such states are an indication for surgical intervention.

Visceral-vegetative violations

Regardless of the localization of damage, visceral-vegetative violations are manifested, first of all, in violations of the pelvis organs (stool delay and urination). In addition, at high injuries, the mismatch of the activity of the digestive tract organs is there: an increase in the release of gastric juice and pancreatic enzymes while reducing the selection of intestinal juice enzymes.

The speed of blood flow in tissues is sharply reduced, especially in zones with reduced sensitivity, microlimphottok is disturbed, the phagocytic ability of blood neutrophils is reduced. All this contributes to the rapid formation of difficult to treat beds.

The full gap of the spinal cord is often manifested by the formation of extensive bedding, the ulceration of the gastrointestinal tract with massive bleeding.

Treatment of spinal injuries and spinal cord

Basic principles for the treatment of spinal injury and spinal cord: timeliness and adequacy of first aid, compliance with all rules in the transportation of victims to a specialized department, long-term treatment with the participation of several specialists and subsequent re-courses of rehabilitation.

When providing first aid, much depends on the timely diagnosis of injury. It should always be remembered that in the case of automotive disasters, drops from the height, buildings, etc., it is necessary to take into account the possibility of damage to the spinal column.

When transporting victims with an injury of the spine, it is necessary to take all precautions in order not to increase damage. Such patients cannot be transported in a sitting position. The victim is placed on the shield. At the same time, an inflatable mattress is used for the prophylactication. With the defeat of the cervical spine, the head is additionally immobilized using special devices (tires, head-breaker collar, etc.) or girlfriend (sand bags).

If you use soft stretcher, the victim to be put on the stomach, and under the chest to put a thin pillow under the chest for additional extension of the spine.

Depending on the type of spine injury, treatment at the hospital stage can be conservative or surgical.

With relatively light stable spinal injuries (distortions, whip injuries, etc.), bedding, massage, thermal procedures are shown.

In more severe cases, conservative treatment consists in a closed correction of deformations (simultaneous returns or extracts), followed by immobilization (special collars and corsets).

Open surgical elimination of deformation removes the compression of the spinal cord and contributes to the restoration of normal blood circulation on the affected area. Therefore, the growing symptoms of damage to the spinal cord, indicating its compression, are always an indication of urgent surgery.

Surgical methods also resort in cases where conservative treatment is inefficient. Such operations are aimed at reconstructing damaged spinal segments. In the postoperation period, immobilization is used, with readings - stretching.

The victims with signs of the injury of the spinal cord are hospitalized into the separation of intensive therapy. In the future, such patients are supervised by a traumatologist, neurosurgeon and rehabilitol.

Rehabilitation after the injuries of the spine and spinal cord

Restoration after the injuries of the spine - the process is quite long.
In the injuries of the spine, not complicated by damage to the spinal cord, is shown by the LFC from the first days of injury: first it consists of exercises for respiratory gymnastics, from the second week they are allowed to move the limbs. Exercises are gradually complicated, focusing on the overall condition of the patient. In addition to the excess of the spine with uncomplicated injuries, massages and thermal procedures are successfully used.

Rehabilitation during the spinal cord damage is supplemented with electrical thermal therapy, igloreflexia. Medicase treatment includes a number of drugs that enhance the processes of regeneration in the nervous tissue (methyluracil), which improve blood circulation (Cavinton) and intracellular metabolic processes (nootropyl).

Anabolic hormones and tissue therapy (vitreous body, etc.) are also prescribed to improve the metabolism and acceleration of recovery after injury.

Today, new neurosurgical methods (embryonic tissue transplantation) are being developed, methods of conducting operations reconstructing the affected segment are being enhanced, clinical trials of new drugs are carried out.

With the difficulties of treatment and rehabilitation after the injuries of the spine, the emergence of a new industry of medicine - vertebrology is connected. The development of the region has a lot of social importance, since, according to statistical data, the spinal injury leads to disabilities the most active part of the population.

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Although the methods of diagnosis and assistance in damage to the spine and the spinal cord were brought back in Egyptian papyrus and the writers of the hippocratic, for a long time, the spinal injury with neurological disorders was considered almost mortal verdict. Even in the first world war, 80% of wounded in the spine died during the first 2 weeks. Progress in the treatment of spinal cerebral injury (SMT), based on improving the understanding of its pathogenesis and the development of radically new treatments, was outlined only during the Second World War and in the postwar years. Today, SMT remains heavy, but usually not a fatal type of injury, with a significant contribution to minimizing its consequences makes a timely and adequate provision of first, qualified and specialized medical care victims.

Traumatic damage to the spine and the spinal cord is significantly less common than the CMT. In adults, the SMT frequency is 5 per 100 thousand population a year, in children it is even lower (less than 1 per 100 thousand population per year), but children's SMT are more often associated with a political science and is heavier, with the worse forecast. In Russia, approximately 80% of victims make up men under the age of 30. Since today, most of the victims even with severe SMT survive, the number of persons with the consequences of SMT in the population of developed countries are approximately 90 per 100 thousand population (for Russia today is about 130 thousand people, of which 13 thousand - with paraplegia or tetraplegia) . The social significance of the problem is difficult to overestimate.

The main cause of SMT - road accidents (50% of cases). Next, followed by sports injuries and related to active recreation (25%, 2/3 of them are damage to the cervical spine and spinal cord, obtained by diving in a small place). In about 10%, the production and production and obtained injuries are injured, and 5% - obtained during falling from height, in natural cataclysms, etc.

Most often the cervical spine is damaged (55%), less often - chest (30%), even less often - lumbly-sacral (15%).

Damage to the spinal cord and its roots occurs approximately 20% of SMT cases. Such injuries are called complicated.

Level damage (lesions) spinal cordestimated by the lower segment, in the dermatoma of which the sensitivity is preserved and at least minimal arbitrary movements. Often, but not always, this level corresponds to the established level of damage to the spine. It should not be evaluated by the level of damage to the spinal cord to focus on pathological reflexes (Babinsky, Rossolimo, Oppenheim, Protective and Sinknesia), their reflex arc can be held below the level of complete damage to the spinal cord.

Highlight fulland incomplete damage to the spinal cord.With full damage (group A on the Frankel scale) there are no sensitivity and arbitrary movements below the lesion level. Usually, in such a situation, the spinal cord is anatomically destroyed. With incomplete damage (group B, C, D on the Frankel scale), sensitivity and movement disorders are expressed to a greater or lesser extent; The E group corresponds to the norm.

Damage to the spine and spinal cord are divided into openat which the integrity of the skin and the subject to soft tissues is disturbed, and closedin which these damage is absent. In peacetime, closed SMT prevails.

TableScial Estimating Disorders of the Spinal Cord (Frankel)

Closed damage to the spine and spinal cord

Full defeat		No arbitrary movements and sensitivity below the lesion level
Save only sensitivity		Below the level of the lesion there are no arbitrary movements, sensitivity is saved
Movements are preserved, but non-functional		Below the level of the lesion there are arbitrary movements, but without a useful function. Sensitivity can be as preserved and no
Movements are saved, functional		Functional useful arbitrary movements below the level of lesion. Various sensitivity disorders
Normal motor function		Movement and sensitivity below the lesion level are preserved, pathological reflexes are possible.

Damage to the spine.Closed spinal damage arise under the influence of excessive bending, extension, rotation and compression along the axis. In many cases, there is a combination of these mechanisms (for example, with the so-called whip injury of the cervical spine, when, after the bending of the spine, its extension occurs).

As a result of the impact of these mechanical forces, a variety of changes in the spine are possible:

Stretching and breaking ligaments;

Damage to intervertebral discs;

Subways and dislocations of the vertebrae;

Vertebral fractures;

Fractures.

The following types of vertebral fractures are distinguished:

Fractures of the bodies of the vertebrae (compression, common, explosive);

Rear semir fractures;

Combined with a simultaneous fracture of bodies, arms, articular and transverse processes;

Isolated fractures of transverse and sausage processes.

Important value of the damage to the spine to stableor unstable.Under the stability of the spine understand the ability of its structures to limit their mutual displacement so that it does not damage or irritating the spinal cord in physiological loads and its roots. Unstable damage to the spine is usually associated with a breakdown of bundles, a fibrous ring, multiple destruction of bone structures and is fraught with additional trauma of the spinal cord even with minor movements in the affected segment.

It is easier to understand the reasons for the emergence of the spinal instability, if you turn to the concept of Denis, highlighting 3 support systems (column) of the spine: frontthe reference complex (pillar) includes the front longitudinal bundle and the front segment of the vertebral body; middlea pillar combines the rear longitudinal bundle and the rear segment of the body of the vertebra; rearpillars - articular processes, handles with yellow ligaments and spinning processes with their ligament apparatus. The violation of the integrity of two of the mentioned support complexes (pillars), as a rule, leads to instability of the spine.

Damage to the spinal cord.Denis scheme: highlighted front, middle and rear support complexes (pillars) of the spine; The instability of the vertebrate segment develops with the defeat of two of them in any combination

In terms of the injury of the spinal cord allocate it concussion, bruised, compressionand violation of anatomical integrity (partial or complete spinal cord break); Often these mechanisms are combined (for example, a bruise with a rupture of vessels and hemorrhage - hematomethyelia, causing direct damage to axons and spinal cord cells). The most severe form of local damage to the spinal cord is its full anatomical break with the diastasis of the ends in the place of damage.

The main value for the patient's fate is the degree of damage to the spinal cord and its roots. This damage can occur both at the time of injury (which is incurable) and in the subsequent period, when the prevention of secondary damage to the spinal cord is potentially possible.

Today there are no ways to restore the function of anatomically damaged neurons and spinal cord cells. The task of treating SMT is minimizing the secondary damage to the spinal cord and ensuring optimal conditions for the restoration of neurons and axons, which found themselves in the zone of blood supply disorder - "ischemic half".

A frequent and dangerous consequence of the spinal cord injury is swelling due to both an increase in tissue osmotic pressure during the destruction of cell membranes and impaired venous outflow due to the compression of the spinal brain vein (hematomas, bone fragments, etc.) and their thrombosis. The increase in the spinal cord volume as a result of edema leads to an increase in local hypertension and a decrease in perfusion pressure, which, according to the principle of the vicious circle, leads to a further increase in edema, ischemia and can lead to an irreversible damage to the entire spinal cord variation.

The clinical picture of the spine damage.In addition to the listed morphological changes, both functional disorders caused by disorders at the cellular level are possible. Such disorders of the spinal cord function regress, as a rule, during the first 24 hours after injury.

The main manifestation of the spinal fracture is local pain, significantly increasing under load (insertion, slopes and even turns in bed). The spine damage can also indicate:

Abrasions and hematomas;

Swelling and local soreness of soft tissues in the paravertebral region;

Soreness in palpation of ostic processes;

Miscellaneous distance between the vertices of the ostic processes, the displacement of one or several of them kovedes, for the stop or to the side of the midline;

Angular change in the axis of the spine (traumatic scoliosis, kyphosis or lordosis).

With a fracture of the Nizhneggudinal and lumbar spine, even without damage to the spinal cord, the intestine paresis, due to the retroperitoneal hematoma (squeezing vessels and the nerves of mesenter), can develop.

Clinical painting of spinal cord lesions during spinal injury

The clinical symptoms of the complicated spinal fracture is determined by a number of reasons, first of all, the level and degree of spinal cord.

The syndromes of the complete and partial transverse damage of the spinal cord are distinguished.

For syndrome of full transverse damage of the spinal cordthe book on the level of the defeat there is no all arbitrary movements, there is sluggish paralysis, deep and skin reflexes are not caused, there are no all types of sensitivity, there is no control over the functions of pelvic organs (involuntary urination, disruption of defecation, priapism); Vegetative innervation suffers (sweating, temperature regulation). Over time, the sluggish paralysis of the muscles can change their spasticity, hyperreflexia, the automatisms of the functions of the pelvic organs are often formed.

Damage to the neck thickening of the spinal cord (CV-THI at the level of V-VII cervical vertebrae) leads to the peripheral parapapaprement of the upper limbs and spastic parapiley of the lower. Conductive disorders arise all types of sensitivity below the lesion level. Possible pains of root character in their hands. The defeat of the cilospinal center causes the appearance of a horn symptom, decrease in blood pressure, slowing down the pulse.Features of clinical manifestations of the spinal cord injury depend on the level of lesion. In case of damage to the upright part of the spinal cord (CI-IV at the level of the I-IV cervical vertebrae), a tetrapreapes or a spastic tetraplegia are developing with a loss of all types of sensitivity from the corresponding level. If there is a concomitant damage to the brain barrel, bilbar disorders appear (dysfagia, aphony, respiratory and cardiovascular disorders).

The injury of the chest part of the spinal cord (THII-XII at the level of I-IX breast vertebrae) leads to the lower spastic paraplegia with the lack of all types of sensitivity, the loss of abdominal reflexes: the upper (THVII-VIII), the middle (THIX-X) and the lower (THXIF Xii).

In case of damage to the lumbar thickening (Li Sii at the level of X-XII, the chest and I lumbar vertebrae) occur the peripheral paralysis of the lower extremities, the anesthesia of the perineum and legs of the book from the groove (pipe) bundle, the cremaster reflex falls.

When traumating the spinal cord cone (SIII-V at the I-II level level) there is a "saddot" anesthesia in the crotch area.

The damage to the horse-tail is characterized by peripheral paralysis of the lower extremities, anesthesia of all types in the area of \u200b\u200bthe perineum and legs, sharp root pains in them.

With the damage to the spinal cord cone and the kores of the horse tail suffers, the segmental apparatus of the spinal cord is suffering and develops the "hyplexic neurogenic bladder" syndrome: the retention of urination with the phenomenon phenomenaDamage to the spinal cord at all levels are accompanied by urination disorder, defecation and sexual function. In the transverse damage to the spinal cord in the cervical and chest parts, there are violations of the function of the pelvic organs by the type of syndrome of the hyperreflex neurogenic bladder syndrome. At first, after injury, urination delay occurs, which can be observed for a very long time (months). The sensitivity of the bladder is lost. Then, as the segmental apparatus of the spinal cord is being processed, the urine delay is replaced by the spinal automatism of urination. In this case, involuntary urination occurs with a slight accumulation of urine in the bladder.

ishuria - the bladder is filled with, but when the pressure in it begins to exceed the resistance of the sphincters, part of the urine passively implies, which creates the illusion of the safety of urination.

Disorders of defecation in the form of a stool delay or incontinence of feces are usually developing in parallel with urination disorders.

The damage to the spinal cord in any parts accompany the strags, arising in areas with impaired innervation, where bone protrusions are located under soft tissues (sacrons, ridges of ileal bones, heels). Especially early and quickly developing straggings with rude (transverse) damage to the spinal cord at the level of the cervical and chest departments. Prolesiders are rapidly infected and the cause of sepsis is caused.

When determining the level of damage to the spinal cord, it is necessary to take into account the interjection of the vertebrae and the spinal cerebral segments. It is easier to compare the location of the spinal cord segments with the masculine processes of the vertebrae (with the exception of the lower thoracic). To determine the segment to the vertebral number, it is necessary to add 2 (so, at the level of the ostic process III of the breast vertebra, the V thoracic segment will be located).

Several syndromes of partial damage to the spinal cord are isolated.This pattern disappears in the Nizhnegorudnaya and Upper-Divine Departments, where at the THXI-XII and LI level there are 11 spinal cord segments (5 lumbar, 5 sacrats and 1 smoke).

Half blasting syndrome (Brownsek's syndrome) - paralysis of the limbs and a violation of deep species of sensitivity on the side of the damage to the fraction of pain and temperature sensitivity on the opposite side. It should be emphasized that this syndrome in the "pure" form is rarely found, its individual elements are usually detected.

Front spinal cerebral syndrome- Bilateral paraplegia (or parapaperse) in combination with a decrease in pain and temperature sensitivity. The cause of the development of this syndrome is a violation of blood flow in the anterior spinal artery, which is injured by the bone fragment or the discovered disc.

Central spinal cord syndrome (more often occurs with a sharp refiguration of the spine) is characterized mainly by the paresis of hands, the weakness is less pronounced in the legs; There are different degrees of severity of the sensitivity of sensitivity below the level of lesion, urination delay.

In some cases, mainly during injury, accompanied by a sharp flexion of the spine, may develop syndrome lesion rear spinal cord- Loss of deep species of sensitivity.

For damage to the spinal cord (especially with full damage to its diameter), violations of the regulation of functions of various internal organs are characteristic: respiratory disorders during the neck lesion, intestinal paresis, violation of the function of the pellets, trophic disorders with a rapid development of bedding.

In the acute stage of injury, the development of the "spinal shock" is possible - decrease in blood pressure (usually not lower than 80 mm Hg. Art.) In the absence of signs of polytrauma and internal or outer bleeding. The pathogenesis of the spinal shock is explained by the loss of sympathetic innervation below the place of damage while maintaining the parasympathetic (causes bradycardium) and the atony of skeletal muscles below the level of damage (causes blood deposit in the venous vein with a decrease in circulating blood volume).

Concussion of spinal cord it is very rare. It is characterized by damage to the spinal cord of a functional type in the absence of obvious structural damage. Paresthesia are more often observed, sensitivity disorders below the injury zone, less often - paresis and paralysis, disorders of the pelvic organs. Occasionally, clinical manifestations are rudely pronounced, up to the painting of complete damage to the spinal cord; Differential-diagnostic criterion is the full regress of symptoms during the day.Clinical forms of damage to the spinal cord

The cerebrospinal fluid by shaking the spinal cord is not changed, the patency of the subarachnoid space is not broken. Changes in the spinal cord with MRI are not detected.

Spinal brain injury - The most frequent type of lesion with closed and impenetrable spinal cord injuries. The injury occurs when the vertebral is turned off with its displacement, the reclipse of the intervertebral disc, the vertebral submission. When the spinal cord injury, structural changes in the brain substance, roots, shells, vessels (focal necrosis, softening, hemorrhage) always occur.

The nature of motor and sensitive disorders is determined by localization and vastness of injury. Due to the injury of the spinal cord, paralysis develops, changes in sensitivity, violation of the function of pelvic organs, vegetative disorders. Injury often leads to the emergence of one, but several foci of the injury. Secondary disorders of the spinal blood circulation can determine the development of foci of softening the spinal cord after a few hours or even days after injury.

The injuries of the spinal cord are often accompanied by subarachnoid hemorrhage. In the cerebrospinal fluid, the blood admixture is detected. The subtleship of the subarachnoid space is usually not violated.

Grinding spinal cord it occurs when the vertebrae is broken with the displacement of fragments or when dislocation, the hernia of the intervertebral disk. The clinical picture of the spinal cord compression may occur immediately after injury or be dynamic (increasing with the movement of the spine) in its instability. As in other cases of SMT, symptomatics is determined by the level of damage, as well as the severity of compression.Depending on the severity of the injury, the restoration of disturbed functions occurs within 3-8 weeks. However, with severe bruises that exciting the entire spinal cord variation, lost functions may not be recovered.

Severe and chronic spinal cord compression. The latter mechanism takes place while maintaining a comprementing agent in the post-traumatic period (bone fragment of the discharged disk, occasional epidural hematoma, etc.). In some cases, with moderate compression, a significant or complete regression of symptoms is possible, but the appearance of them again in the remote period due to chronic traumatization of the spinal cord and the development of myelopathy focus.

Allocate so-called hyperextenzion injury of the cervical spine (whip injury) arising from automotive catastrophes (a blow from behind with incorrectly installed head restraints or their absence), diving, falling from height. The mechanism of this spinal cord injury is a sharp re-installing of the neck, exceeding the anatomical functionality of this department and leading to a sharp narrowing of the spine with the development of a short-term compression of the spinal cord. The morphological focus is similar to this with such when injected. Clinically hyperextenzion injury is manifested by various spinal brain damage syndromes - a root, partial disruption of the spinal cord function, full of cross-lesions, anterior spinal artery syndrome.

Hematomyiel, if not combined with other forms of structural damage to the spinal cord, is characterized by a favorable forecast. Neurological symptoms begins to regress in 7-10 days. The restoration of disturbed functions can be complete, but certain neurological disorders remain more often.Hemorrhage in the spinal cord. Most often, hemorrhage occurs when the vessels of the central channel and the rear horns at the level of lumbar and cervical thickens. The clinical manifestations of hematomy cells are due to the squeezing of the rear horns of the spinal cord of the incered blood propagating on the 3-4 segment. In accordance with this, segmental dissociated sensitivity impairment (temperature and pain), located on the body in the form of a jacket or semi-curtain. When blood spreading to the region of the front horns, peripheral sluggish paresses with atrophyes are revealed, with the defeat of lateral horns - vegetative-trophic disorders. Very often in the acute period, not only segmental disorders are observed, but also conductive sensitivity disorders, pyramidal symptoms due to pressure on the side rope of the spinal cord. With extensive hemorrhages, a picture of the full transverse damage of the spinal cord is developing. The cerebrospinal fluid may contain a blood admixture.

Hemorrhage in space surrounding the spinal cord it can be both epidural and subarachnoidal.

Epidural spinal hematoma, in contrast to intracranial, usually occurs as a result of venous bleeding (from the surrounding TMO venous plexuses). Even if the source of bleeding is the artery, passing in an assault or bone, the diameter of it is small and bleeding quickly. Accordingly, the spinal epidural hematomas rarely achieve large sizes and do not cause coarse compression of the spinal cord. The exceptions are hematomas due to damage to the vertebral artery at a turn of the cervical spine; Such victims typically die from circulatory disorders in the brain barrel. In general, epidural spinal hematomas are rare.

Clinical manifestations.For epidural hematomas, an asymptomatic gap is characteristic. Then, a few hours after injury, root pains with different irradiation appear depending on the localization of the hematoma. Later develop and begin to increase the symptoms of the transverse compression of the spinal cord.The source of subdural spinal hematoma can be both the vessels of the TMO and the spinal cord and epidural vessels located at the place of traumatic damage to the TMO. Subdural spinal hematomas are also rare, usually bleeding inside the fool bag are not accomplished and are called spinal subarachnoid hemorrhages.

For the clinical picture of the subordinate (subarachnoid) hemorrhage during the injury of the spinal cord, it is characteristic of the acute or gradual development of symptoms of irritation of shells and spinal roots, including those located above the injury. There are intense pains in the back, limbs, the rigidity of the cervical muscles, the symptoms of Kernig and the Brudzinsky. Very often they are joined by paresis limbs, conduction disorders of sensitivity and pelvic disorders due to the damage or compression of the spinal cord of the spearing blood. The diagnosis of hematurachis is verified in lumbar puncture: the cerebrospinal fluid is intensely painted with blood or xanthophrom. The course of hematorium - regressive, often comes full recovery. However, hemorrhage to the horse-tail area may be complicated by the development of the adhesive process with severe neurological disorders.

Anatomical damage to the spinal cord it occurs at the time of injury or in secondary traumatization of the spinal cord with a wonderful object, bone frails, or when its extracting and breaking. This is the hardest form of SMT, since the restoration of the anatomically damaged spinal cord structures never happens. Occasionally, anatomical damage is partial, while developing brown-secarar syndrome or other of those described above, but it happens more often. Symptomatics is determined by the character and level of damage.

Spinal cord -this is a nervous fabric going down from the brain in the spinal back of the back. The spinal canal is surrounded by a spine as a bone structure that protects the spinal cord from various damage.

Thirty-one spinal nerve departs from the spinal cord to chest, belly, legs and hands. These nerves give the brain team to move those or other parts of the body. In the upper part of the spinal cord there are nerves, hand-headed, heart, lungs, in the lower legs, intestines, urinary bubble, and so on. Other nerves return from the body information brain - a feeling of pain, temperature, body position, and so on.

Causes of damage to the spinal cord

• road trauma
• falling from height
• sports damage
• brain tumor
• infectious and inflammatory processes
• aneurysm Vessels
• long decrease in blood pressure

The spinal cord, unlike other parts of the body is unable to recovery, so damage leads to irreversible processes. Damage to the spinal cord It may be the result of not a single process: this is the injuries of the spine, and blood supply disorders, and infection, and tumors, etc.

Damage to the spinal cord

Pronounced symptomatics The damage to the spinal cord is manifested depending on the two factors: the location of damage and the degree of damage.

Location of damage.

The spinal cord may be damaged either at the top or lower. Depending on this, the symptoms of damage is distinguished. If the upper part of the spinal cord is damaged, then more paralysis causes such damage. For example, fractures of the upper spoken departments, especially the first and second cervical vertebrae, leads to - both hands and both legs. At the same time, the patient is able to breathe only with the help of an artificial respiratory apparatus. If the lesions are located below - in the lower spoken departments, then only legs and the lower part can be paralyzed.

Degree of damage.

The severity of the spinal cord damage is distinguished. Damage can be both partial and complete. This again depends on the place of damage - that is, which part of the spinal cord in this case was susceptible to damage.

Partial damage to the spinal cord. With this form, the damage to the spinal cord transmits only some signals in the brain and back. In this regard, patients have sensitivity, but only to some extent. And also stored separate motor functions below the lesion area.

Full damage to the spinal cord. With full, the full or almost complete loss of the motor function, as well as the sensitivity below the affected area occurs. But I must say that the spinal cord even with full damage will not be converted. But only a spinal brain subjected to partial damage is subject to restoration, while completely damaged brain is not restored.

Symptoms of spinal cord damage

• intensive burning and pain
• inability to move
• partial or complete loss of sensitivity (heat, cold, tactile sensations)
• inability to control the work of the bladder and intestines
• light cough, breathing difficulty
• change of sexual and childbearing functions

Critical symptoms

• from time to time loss of consciousness
• loss coordination
• numbness in the fingers and legs, in brushes and feet
• paralysis parts of the body
• the curvature of the neck and back