Signs of transverse spinal cord injury due to injuries at the level of the thoracic and lumbar spine are paralysis (lack of active movements) of the legs and pelvic disorders (fecal and urinary incontinence). The most severe injuries are accompanied by paralysis of the arms and legs, breathing disorders, and incontinence - this is a violation of the integrity of the spinal cord in the neck area. And damage to the highest parts, the transition zone between the brain and the spinal cord, leads to instant death.
If the victim is conscious, then he is immediately asked a question about the location of the pain. When he lies on his back, with his hand under his back, they press on the spinous processes (bone outgrowths that extend from each vertebra in the posterior direction, their tips are easily identified under the skin in the form of hard tubercles located along the midline of the back) and at the place of greatest pain determine the possible location of the fracture.
First aid for spinal injury
If the situation allows, you should not turn or transport the victim until examined by a doctor. It is possible to place an injured person on a stretcher only if there are several assistants, and one of them must fix the head with his hands, preventing it from turning or tilting forward or backward; the rest are distributed along the body on one side.
If the victim is lying on the ground or floor, then before this manipulation all assistants kneel down on one knee. Hands are carefully placed under the victim and, at the command of one of the rescuers, they are lifted smoothly and evenly. Another assistant places a rigid (“spinal”) stretcher under the raised body, acting synchronously, the rescuers hold the patient suspended, and then lower him onto the stretcher, where he must be securely secured with straps and (he should) be prohibited from moving independently.
The stretcher should be transported very carefully, avoiding excessive bending and rolling of the victim. Along the route, you need to constantly monitor the position of the body and the condition of the victim (primarily, for loss of consciousness and vomiting).
The cervical region is characterized by the greatest mobility (the range of movements is maximum) with very limited possibilities of fixation; in addition, the osteoarticular apparatus of this department is quite fragile. With sudden displacements of the body relative to the head, the so-called whiplash mechanism easily occurs, which is especially dangerous if the head is thrown back at the first moment. This is possible for passengers in cars with seats without head restraints, when another vehicle crashes into a stationary or slowly moving vehicle from behind at high speed. In such cases, a fracture or displacement of the vertebrae relative to each other occurs with transverse damage to the spinal cord.
Signs and symptoms of damage to the cervical spine due to spinal trauma are severe pain with the slightest movements, and sometimes unnatural fixation of the head position. If the spinal cord is damaged, paralysis of the arms and legs with loss of sensation in the body and limbs, respiratory failure, and urinary and fecal incontinence are observed.
Even if a fracture of the cervical spine is not obvious, but is only suspected (if the victim is unconscious, has a traumatic brain injury, etc.), then first aid should consist of fixing the spine in the cervical spine. Unfortunately, it will not be possible to achieve complete fixation, but conditions can be created so that the head and cervical spine acquire relative stability. Those providing assistance should support the victim’s head with their hands when shifting and turning, and also fix it during transportation.
For relative immobilization, a neck corset (“collar”) is used in the form of a thick, rigid roller made of clothing, dense foam rubber or other material. The roller needs to be wrapped around the neck, avoiding compression of the larynx, trachea and carotid arteries, then fix its ends in front. Neglecting to fix the head with your hands, using a corset or “collar” with one careless movement can turn a situation that was fixable into an injury with catastrophic, sometimes fatal consequences.
Fractures in the thoracic region occur relatively rarely due to the protection of this area by the rib frame and muscles, but if the spinal cord is damaged at the chest level, it is also possible to develop paralysis of the legs and disable the functions of the pelvic organs. This happens when there is a blow to the area of the spinal column or excessive flexion/extension of the body, for example, when being in a collapse.
The transitions from the thoracic region to the lumbar region and from the lumbar region to the sacral region are critical in the spine. Fractures and displacements often occur in these places, which is facilitated by age-related changes in the spine. There is no spinal cord at the level of the transition of the lumbar to the sacral, but transverse damage can lead to weakness in the legs, impaired sensitivity and function of the pelvic organs due to compression of the large roots of the spinal cord.
The victim must be handled with extreme caution. The body, head, limbs must be moved and rotated as if they had merged into one rigid monolith.
Victims with spinal injuries (even if the injury is only suspected!) are transported only on rigid stretchers. To do this, use a narrow shield. As a last resort, you can make a stretcher from interconnected wooden slats and outer clothing, but if they turn out to be soft, then the patient must be laid on his stomach.
Only doctors can provide further assistance to such victims.
Focusing on spinal injuries, the following injuries are distinguished:
This type of injury can occur in the lumbar, thoracic or cervical spine. It is also important to consider the degree of damage - open or closed wounds.
A spinal bruise is characterized by a rolling pain at the site of the injury. Upon examination, signs of swelling and hemorrhage are revealed.
Ligament ruptures, or distortions in other words, occur during large and sudden lifting of heavy objects. Ligaments are torn or torn, the body feels piercing pain, and movement is limited. Symptoms of sciatica may appear. There are no displacements of the vertebrae or dysfunction of the spine.
Fractures of the spinous processes occur during strength training, with excessive muscle contraction. Fractures of the transverse processes are more common than the spinous ones, but are caused by the same reasons. Symptoms characterizing these fractures: Payr's symptom and stuck heel symptom. The first is pronounced, intensifying pain when turning to the side in the paravertebral region. The second is pain on the side of the injury, when lying on your back it is impossible to raise your straightened leg. In addition, a symptom of radiculitis may occur at the site of injury.
Cervical injuries - whiplash involve injuries with neurological symptoms, the most dangerous to human life. They can occur as a result of car accidents or jumping into water from a height. Symptoms of a cervical spine injury: breathing and cardiac activity are disrupted, cardiac arrest is possible, failure of internal organs, complete paralysis of the body.
Injuries are less dangerous, with a smaller lesion: loss of muscle strength in the body, arms and legs, nervous disorders. They may manifest themselves as bursts of increased tone, due to damage to the nerve endings that lead to the muscles. This interferes with movement and leads to changes in muscle structure. Most often, the degree of damage to the cervical spine depends on the age of the patient.
Due to age, in older people the spinal cord is more severely injured, osteochondrosis or osteophytes appear, which leads to changes in the spinal canal. Headaches and neck pains appear, memory is impaired, neuralgia, numbness in the arms and legs. In young people, this kind of damage is temporary and passes quickly, while in old people serious changes can be detected, including paralysis of all limbs.
Symptoms of thoracic injuries (fractures, fractures-dislocations) are pain in the spine, radiating to the heart area. In this case, sensitivity and movement of the chest and arms are impaired.
Symptoms of lumbar injuries are manifested by: weakness of muscle strength, paralysis of the legs, nervous disorders, weakening of receptor irritation. Frequent dysfunctions of the genitourinary system - urinary incontinence, erectile dysfunction.
Fractures-dislocations or fractures of the lumbar and thoracic regions are similar in general symptoms: an increase in pain in the fracture area when loading the axis and when tapping on the spinous processes.
The emerging symptoms of spinal injuries are characterized by a feeling of pain, numbness and tingling in the lower extremities, and decreased sensitivity of the muscles in the spinal region. Serious injuries to the spinal column can cause paralysis of the legs or all extremities.
Childhood injuries are not that common. Most injuries are in the cervical spine. As a rule, children suffer pain if they fall from a height. Compression injuries to the child’s bone structure are a peculiar feature of damage. During the birth of a child, a strong pushing load can also cause injury to the cervical spine. Which can subsequently cause headaches, motor problems, and hypertension. Treatment of these injuries requires a special massage technique.
In case of a bruise, the patient needs first aid in the form of an x-ray to exclude the possibility of a fracture, bed rest for 10 days, thermal procedures and massage.
For distortion, treatment should be done in the same way as for bruises, but with bed rest for up to 6 weeks. If distortion in the cervical spine and capsule entrapment are detected, traction using a Shants collar will be required. It is recommended to numb the pain with a 1% solution of novocaine at the site of attachment of the ligaments. The duration of treatment is up to 10 weeks, rehabilitation and recovery is up to 4 months.
First aid for dislocations or subluxations of the cervical vertebrae, treatment occurs simultaneously or with traction after the injection of an anesthetic into the damaged joint. After these procedures, a plaster half-corset is applied to fix the head. After 4 weeks it is removed and replaced with a Shants collar, which should not be removed for 8 weeks.
In case of serious spinal cord injuries, immediate reduction is performed. With simple injuries, a favorable outcome is possible, and patients return to work. The rehabilitation period is 8 weeks, disability is 4 months. For dislocations with spinal cord damage, the prognosis is unfavorable. Patients either become disabled or die.
A mandatory condition for rehabilitation if you have had a spinal column injury is a visit to a specialized center, consultation and regular visits to specialists (rehabilitologist, traumatologist and neurosurgeon), assistance in restoring lost motor functions. Even if stable dynamics are observed over time, this does not serve as a calm for your body. The consequences may appear later. It will be most effective to begin rehabilitation treatment after a spinal injury as early as possible, since changes in bones and muscles are still reversible. Also, old injuries can be restored with proper treatment.
About 80% of people suffering from spinal column injuries become disabled or die. Almost any spinal injury requires ongoing treatment, not excluding surgery.
Timely and adequate first aid, transportation of the victim according to all the rules to a specialized clinic, long-term treatment with the participation of all specialists and repeated rehabilitation courses - only this will help the patient survive.
When providing first aid for a spinal injury, the wounded person should be placed on a shield or flat surface and secured to avoid further injury. Transporting the patient in a sitting position is strictly prohibited. In case of injury to the cervical spine, the head is additionally supported using a special splint or collar. If the nervous system is damaged, first aid is provided to maintain vital functions.
A victim with a spinal injury needs to be assisted: lay him on his stomach, and place a pillow under his chest if a soft stretcher is used to transport the patient.
In the future, treatment depends on the nature and severity of the damage - surgical and conservative intervention. First aid aimed at changing the deformity and restoring blood circulation at the site of injury will eliminate surgical intervention. Surgical treatment is used as a last resort when conservative methods do not produce visible results.
For mild spinal injuries - whiplash injuries, distortion - first aid in the form of massage, thermal procedures and bed rest is indicated. More severe injuries require conservative treatment: traction or reduction, followed by fixation and wearing a special corset or collar.
Surgical treatment eliminates deformation and relieves compression of the spinal cord, normalizes and restores blood circulation in the affected area. Thus, the pain symptoms of the spinal cord that arise indicate its compression, and are an indicator for urgent surgical intervention. Patients with such signs are hospitalized in the intensive care unit.
By observing basic precautions, you can avoid the dangerous consequences of spinal injury.
Legs are the most important part of our body, thanks to them we can go to work or study, move and live. If the legs stop working, the person becomes incapacitated, he cannot live a normal life, work and take care of himself.
Leg paralysis is a serious pathology that requires the attention of a doctor. Every person should know the first signs of paralysis and immediately go to the hospital when they appear. Early diagnosis and treatment will help avoid serious complications and disability.
Paralysis of the lower extremities is a disease in which there is a complete loss of motor activity in the legs. When partially impaired, the disease is called paresis. The pathology is associated with damage to the nervous system; this occurs with various diseases and spinal injuries.
A patient with paralysis cannot move on his own
Often paralysis is a sign of a serious illness; this pathology occurs quite often, in approximately 2% of people on the entire planet. The disease can be permanent or temporary, it all depends on the cause of the pathology and how soon treatment began after the first symptoms appeared.
There are several classifications of leg paralysis. It is divided into spastic and flaccid. In the first case, muscle tone increases and atrophy is not observed, but in the second case, on the contrary, the muscles relax too much. Flaccid paralysis is a more severe form of the disease that requires bed rest and special treatment.
The occurrence of proximal paresis is associated with injury to the femoral nerve; as a result of this disorder, a person cannot make flexion and extension movements in the leg, the quadriceps muscle weakens, and the anterior surface of the thigh becomes less sensitive.
This pathology is characterized by moderate pain; the pain can be severe in people with diabetes. Proximal paresis occurs infrequently, usually in people with serious problems in the body, such as Guillain-Barré syndrome, when the immune system attacks nerve cells in the body.
Distal paralysis is divided into several types, depending on the cause of its occurrence and location:
This type of paralysis is divided into the following types.
Monoparesis occurs due to spinal cord injury, ischemic stroke and the presence of a tumor near the spine. In this case, one leg is paralyzed, and the second loses superficial sensitivity.
Lower paraparesis. The disease can be associated with damage to the spinal cord and, less commonly, the brain; it develops rapidly, paralyzing all muscle groups of the legs.
Spinal cord injuries. This pathology occurs when the spine is fractured, flaccid paralysis occurs, in which urination is impaired and the legs are paralyzed.
Compression of the spinal cord. This pathology occurs when a growing tumor begins to compress the nerve, disrupting its conductivity.
This condition occurs with atherosclerosis, when blood circulation in the spinal cord is disrupted, as well as with mechanical trauma to blood vessels, compression by tumors. Poor circulation leads to loss of sensitivity in the lower extremities and pelvic organs.
An epidural abscess occurs as a result of an infectious disease and is accompanied by characteristic symptoms: fever, chills, pain, and elevated white blood cells. In this case, the symptoms increase very quickly, first there is weakness in the legs, then the function of the legs and pelvic organs is impaired.
Paralysis of the lower extremities occurs for the following reasons:
With paralysis of the legs, the following symptoms are observed:
Paralysis of the lower extremities is a serious pathology that is most often associated with damage to the spinal cord. If a person has lost the feeling of his legs after a fall from a height or after an accident, it is necessary to provide him with first aid correctly. First of all, you need to call an ambulance, as this condition requires immediate hospitalization.
It is not recommended to move the victim yourself, as there is a risk of displacement of broken vertebrae, the exception being the situation when there is a risk of a car explosion, or it is necessary to take the patient to the hospital yourself. In this case, a special spinal shield is used to carry victims.
If a person is conscious, he must be given an anesthetic. And when carrying, carefully lift the body so that the spine is motionless. Very often, such injuries require artificial ventilation.
Treatment of paralysis of the lower extremities is carried out by a neurologist (neurologist). He carefully examines the patient, listens to complaints and takes an anamnesis. To confirm the diagnosis, the patient is referred for the following studies:
If the patient has any diseases, he may be referred for consultation to specialized specialists, for example, an endocrinologist, therapist, infectious disease specialist, immunologist, etc.
In each case, treatment is selected individually, taking into account the severity of the pathology, the patient’s age, and the cause of the disease. First of all, the doctor deals with eliminating the cause of paralysis.
Massage as a method of treatment
For this, medication and surgical operations may be indicated, and to restore the function of the limbs, conservative treatment is prescribed, in particular massage, physiotherapy, and special therapeutic exercises.
The most important part of conservative treatment is physical therapy. The doctor prescribes special passive and active exercises that are aimed at restoring leg function. Gymnastics is necessary to prevent muscle atrophy and joint contracture.
Almost all patients are advised to visit the pool when movements become more active. Swimming helps to engage all muscle groups, strengthen them and improve tissue nutrition.
Physical education is indicated even in very severe cases, as it helps to develop the heart, respiratory system, and does not allow stagnant processes to occur in tissues and blood vessels. But it is very important when performing exercises to use not only the sore side, but also the healthy one.
In addition, conservative treatment includes massage, preferably performed by a specialist. Proper massage helps to normalize blood circulation in the tissues and prevent their atrophy; in case of spastic paralysis, a course of massage will perfectly relax the muscles, and in case of sluggishness, on the contrary, it will tone the muscles.
For paralysis, the following drugs are prescribed:
The doctor selects all medications individually, calculating dosages for each patient. Self-medication with the drugs described above can be dangerous to health, since most of them have serious contraindications and side effects.
Surgery may be indicated in the following cases:
Folk remedies can be used in complex treatment after consultation with a doctor. It is worth understanding that despite the sufficient effectiveness of traditional medicine recipes, they cannot cure the causes of paresis, so the disease will still progress.
The following folk remedies will help improve the condition of paralysis:
As a rule, only a doctor can talk about the prognosis of the disease, since in each case it will be different, it all depends on the type of paralysis, the cause of its occurrence, and on the human body. Paralysis of the lower extremities can provoke the following complications:
In most cases, it is possible to avoid serious complications if you consult a doctor in a timely manner and undergo treatment, following all the specialist’s recommendations. It is very important not to be lazy, do all the exercises, do the massage yourself, and for the best effect, do not neglect folk remedies. The patient should not lie in bed all day unless indicated.
Spinal injuries are a fairly common pathology today and account for 17–25% of all traumatic injuries. In addition, in 20–35% of cases, spinal injury is combined with damage to the spinal cord, which runs directly inside the vertebrae. Then such an injury is called spinal injury and, as a rule, has serious consequences for human health.
The causes of spinal injuries are very diverse and are often directly related to modern developments in technology: high-speed cars, high-rise buildings, high pace of life. The most common among them:
diver's injury. It occurs when a person jumps like a fish into a body of water, not knowing the bottom topography. When immersed in water, the diver hits invisible obstacles (rocks, shallow bottom) with his head, it tilts back, and under the influence of body weight, the cervical spine is injured.
- road traffic accidents. In this case, a person can get injured while in a car or be injured as a pedestrian.
— a fall from a height is always accompanied by damage to the back, but the injuries are especially serious if the victim lands on his feet. Then the spine is sharply affected by the force of body weight, amplified by the fall, and a compression (from compression) fracture of the spine occurs.
- Back injuries can also be caused by gunshot, knife or other types of wounds. What matters here is the location of the lesion and its permeability.
Spinal injuries can be classified according to several criteria:
- combined spinal injuries (several parts are affected simultaneously);
- with spinal cord damage;
- without spinal cord damage;
3. According to the depth of the lesion:
— penetrating (with damage to the skin and underlying structures);
— non-penetrating (the skin remains intact);
4. By type of injury:
The main clinical manifestations of spinal injuries will be: pain localized at the site of injury or spread throughout the back, and symptoms of neurological pathology. Even if the spinal cord itself is not damaged, the effects of trauma to the spine and surrounding tissues will cause swelling that will put pressure on the spinal cord or the nerves that come from it.
Spinal cord dysfunction will manifest itself differently depending on the location of the injury:
- the most serious and life-threatening symptoms will appear with injury to the cervical spine: impaired breathing and cardiac activity up to cardiac arrest, paralysis of the entire body, dysfunction of internal organs. Milder lesions are manifested by a decrease in muscle strength of the limbs and trunk, and sensitivity disorders. Spastic muscle tension may appear (a constant increase in tone due to damage to the nerves carrying impulses to the muscles). This limits and interferes with movements, and with prolonged hypertonicity, structural changes occur, replacement with connective tissue and muscle shortening, which remains for life.
injuries to the thoracic spine are manifested by symptoms of impaired movement and sensitivity of the arms and chest, and sometimes legs. The pain will be localized in the spine and radiate to the heart area. Deep inhalations or exhalations may also be painful.
- injuries to the lumbar spine are characterized by weakened muscle strength or paralysis of the lower extremities, sensory disorders, decreased reflex strength, and spasticity is possible. The function of the genitourinary system is also often impaired, in the form of urinary retention or urinary incontinence, decreased sensitivity of the perineum and genital organs, and erectile dysfunction.
Quite often there is a situation where a spinal injury occurs in several places at the same time, then the symptoms will be mixed, depending on the affected areas.
Consequences of spinal injuries
The duration of manifestations and the severity of the consequences of a spinal injury depend on many factors: the location and extent of the damage, the involvement of certain spinal cord structures in the process, the severity of the general condition of the victim and the quality of the medical care provided.
In the acute period (from weeks to several months) after injury, clinical manifestations, of course, will be very diverse and unpleasant: pain in the damaged area, impaired movement and sensitivity, and possible long-term immobilization (immobilization) for the purpose of healing of fractures.
But the most important are the long-term consequences - neurological deficits that remain for life or for a very long time. This includes paresis (decreased muscle strength) and paralysis (complete immobilization) of the limbs, spastic phenomena, loss or disturbances of sensitivity, pathology of the functions of internal organs, instability of the spine at the site of injury, and others.
Although all these diagnoses are very serious, today this is not a death sentence! With the help of modern techniques and knowledge in the field of physical therapy, manual therapy, and reflexology, a significant restoration of lost functions is possible. If you have had a spinal injury, be sure to consult a specialist, regardless of how long ago the injury was and its manifestations. Even if you do not notice any consequences after an injury, they may appear later, so regular visits to a doctor are a prerequisite for full rehabilitation. The sooner rehabilitation treatment is started after an injury, the more effective it will be, because pathological changes in muscles and bones are still reversible. But even old injuries, with properly selected treatment, can be quite successfully cured.
Of course, restoring the functions of the spine and spinal cord after injury is a difficult, lengthy and painful matter. But when it comes to the quality and completeness of your future life, you should be patient and, by joining forces with your doctor, confidently move towards your goal - a complete recovery.
With these paresis, flexion of the hip, flexion and extension of the leg are difficult due to weakness of the proximal muscle groups with relatively sufficient strength and range of motion in the distal sections. Proximal paresis can be of either peripheral or central type; the latter option is extremely rare. Peripheral unilateral proximal paresis usually results from traumatic injury to the femoral nerve. Mononeuropathy of the femoral nerve is manifested by limited flexion of the hip and extension of the leg, decreased strength of the quadriceps femoris muscle, extinction of the knee reflex, decreased sensitivity on the anterior surface of the thigh and the anterior inner surface of the lower leg. A special form, equivalent to neuralgic amyotrophy, is the subacute development of atrophic paralysis of the thigh muscles along with severe pain in it. This symptom complex is usually observed in people with diabetes.
Peripheral proximal paraparesis is less common than distal paraparesis. Its acute development is usually observed as part of Landry Guillain-Barre polyneuropathy or with polio, which is now extremely rare. Paralysis is expressed asymmetrically; its occurrence is usually preceded by pain in the legs.
Paresis of one leg is often distal and in most cases peripheral. In this case, movement of the feet is impossible due to damage to the personal or tibial muscle group or their combined damage.
Damage to the peroneal nerve is manifested by foot drop, inability to walk on heels, inability to abduct the foot and raise its outer edge. As a result, a specific gait disorder occurs (cock gait, stepping). Sensation on the dorsum of the foot is impaired. Nerve injury is often combined with a fibula fracture. Protrusion of the intervertebral disc can lead to compression of the radicular artery supplying the corresponding root, in this case LI-Si, which is manifested by weakness of the foot extensors that occurs after sharp pain in the lower leg (so-called paralyzing sciatica). Peroneal nerve entrapment syndrome under the biceps femoris tendon occurs in people who squat or sit for long periods of time (peroneal nerve tunnel syndrome).
Tibial nerve damage most often develops as a result of trauma. Clinically, it is manifested by a violation of the plantar flexion of the foot, the flexion of the toes is also impaired, and the foot is not adducted inward. As a result of denervation of the interosseous muscles, the toes assume a claw-like position. Standing on your toes becomes impossible. The Achilles reflex disappears. Superficial sensitivity is impaired on the posterior outer surface of the lower third of the leg, on the sole and around the outer edge of the foot. Significant vasomotor and trophic disorders may occur.
Damage to the sciatic nerve trunk is often associated with trauma, and is rarely combined with a fracture of the femur. Mononeuropathy of the sciatic nerve can occur due to improperly completed injection (injection neuritis). With discogenic lumbosacral radiculitis, among various muscular-tonic phenomena, contracture of the piriformis muscle is most often observed, which can cause compression of the sciatic nerve. The clinical picture of a complete break of the sciatic nerve is characterized by paralysis of all leg muscles, with the exception of the muscles of the anterior surface of the thigh, and loss of sensitivity on the posterior surface of the leg, the posterior surface of the lower leg and on the entire surface of the foot.
Distal paresis of both legs is usually peripheral. Its acute development is possible with ischemic stroke, paraparesis of the feet can develop after awkward movement, excessive physical activity (lifting weights), and sometimes for no apparent reason. The development of paraparesis may be preceded by pain in the lumbar region. The distal parts of the legs (mainly) can be affected by chronic alcohol intoxication. A person suffering from alcoholism usually does not pay attention to the paresthesias typical of the prodromal period, and the pronounced manifestations of the disease develop acutely or within a few days. The muscles of the legs (and sometimes the arms) become paretic. Initially, the muscles of the distal sections suffer, especially in the legs; in patients, the gait takes on a stepping pattern. A similar picture is observed in case of poisoning with tricresyl phosphate.
Monoparesis (monoplegia) of the leg - paresis or paralysis, uniformly affecting all parts of one leg, most often of a central nature. At the spinal level of damage to the pyramidal fasciculus, monoparesis is usually included in the picture of Brown-Séquard syndrome (damage to half the diameter of the spinal cord); spastic paralysis on the side of the lesion with loss of deep sensitivity in the paralyzed leg and loss of superficial sensitivity in the healthy leg. Brown-Séquard syndrome is most often observed with extramedullary tumors of the spinal cord, less often with its trauma. Another variant of central monoplegia of the leg is a limited lesion of the upper parts of the precentral gyrus. The cause of limited damage to the upper parts of the precentral gyrus, as a rule, is an ischemic infarction in the anterior cerebral artery.
Lower paraparesis (paraplegia), evenly represented in all muscle groups, is often central and less often peripheral. Acute development of lower paraparesis is observed with spinal cord injuries, spinal strokes, infections, toxic and tumor lesions of the spinal cord, cauda equina, and polyneuropathies. In rare cases, lower paresis can also occur with brain damage.
Spinal cord injury usually accompanies a spinal fracture or is caused by a stab wound. In most cases, the acute period occurs with a picture of spinal shock in the form of flaccid paralysis, loss of all types of sensitivity below the level of the lesion and urinary retention. Symptoms of spinal shock at first obscure the true extent of spinal cord damage. A complete anatomical break is evidenced by signs of even slight preservation of any functional system below the level of injury. In this case, the detection of the patient’s perception of stimuli in the anogenital area is of particular importance. Significant and rapid regression of spinal disorders is characteristic of concussion of the spinal cord and mild ischemia. Partial restoration of spinal functions indicates an incomplete break - a bruise or traumatic infarction. The complete absence of any signs of recovery within 2 days is a poor prognostic sign, indicating an anatomical break of the spinal cord.
When the spinal cord is compressed by a metastatic tumor of the spine, in typical cases the connection between the spinal lesion and the metastasis is indicated by progressive emaciation, sallow skin color, sharply increased ESR, and anemia. It is significant that in many cases of cancer metastases to the spine, spondylography does not reveal destruction of the vertebrae. Stroke-like development of lesions across the spinal cord in benign tumors is extremely rare and is associated with compression of the radicular or spinal artery by the tumor.
Acute paralysis of the legs may be a consequence of compression of the cauda equina by a prolapsed intervertebral disc. The clinical picture is characterized by bilateral lumbar ischialgia, flaccid paralysis of the feet, saddle anesthesia and pelvic disorders. A similar picture develops when a disc herniation compresses the radicular arteries, leading to ischemic infarction of the lower spinal cord.
Epidurit (epidural abscess) is a complication of foci of purulent infection of various locations or sepsis: Most often, an epidural abscess is formed at the level of the thoracic spine.
The clinical picture of the disease consists of general infectious symptoms (fever, chills, general malaise, high ESR, neutrophilia) and acutely developing radicular-spinal lesions: increasing back pain, aggravated by coughing and sneezing, which is accompanied by weakness in the legs, impaired sensitivity and pelvic function organs. The clinical picture develops very quickly - from the moment of slight weakness in the legs to the picture of a complete break in the spinal cord, it usually takes several days.
Diagnosis of epiduritis is complicated by the fact that a similar symptom complex is also characteristic of transverse myelitis. It should be remembered that isolated inflammation of the spinal cord substance in the absence of signs of brain damage is very rare. Epidurit requires immediate surgical intervention, while myelitis is treated conservatively. The diagnosis of transverse myelitis should be considered preliminary, requiring in each case a neurosurgical examination, in particular myelography. Lumbar puncture is absolutely contraindicated in lumbar localization of epiduritis due to fear of introducing infection into the intrathecal space.
Spinal stroke can occur with atherosclerosis of the vessels of the spinal cord or the main vessels of the aorta (subclavian, vertebral or iliac arteries), as a result of compression of the spinal cord vessels from the outside, for example, a herniated disc, vertebral fragments due to trauma, extramedullary tumor or inflammatory infiltrate.
Spinal circulation disorders can also be caused by arteriovenous malformations. They are most often located in the cervical spine and at the level of the thoracolumbar junction and represent a tangle of abnormal vessels, the size of which can vary widely. Such a formation can manifest itself as subarachnoid bleeding or ischemic damage to the spinal cord substance as a result of mechanical compression. In some cases, spinal infarction is a complication of dissecting aortic aneurysm. Recognizing the nature of this disease in the early stages of its development is very difficult. As a rule, disorders of the spinal circulation of the ischemic type are much more common than the hemorrhagic type.
The clinical picture of ischemic spinal stroke depends on the extent of ischemia both along the length and diameter of the spinal cord. The most clearly defined syndrome is ischemia of the anterior half of the spinal cord or the so-called anterior spinal artery syndrome, which is characterized by an acute shutdown at one level or another of the blood supply to the anterior 2/3 of the spinal cord. As a result, tetra-or parplegia develops, accompanied by disturbances in superficial types of sensitivity and function of the pelvic organs. The deep muscle sense remains intact, since the blood supply to the posterior columns is not affected. Another similar and relatively common syndrome of spinal circulatory disorders is the symptom complex of switching off the great lumbar artery of Adamkiewicz: acutely developing flaccid paralysis of the lower extremities, dissociated loss of sensitivity with the upper border of the innervation zone from C4 to the innervation zone T12″ dysfunction of the pelvic organs.
The most common cause of spinal cord injury is motor vehicle accidents . Therefore, the first step in such cases is the qualified removal of victims from the vehicle.
In this case, the basic principle must be observed: maintaining the immobility of the body axis - the spine - while correctly transporting the patient on a backboard, excluding flexion, lateral and rotational movements.
In the first hours after injury, anti-shock measures and treatment are carried out aimed at normalizing breathing, blood circulation, eliminating pain, combating anemia, hypoproteinemia, and normalizing hemostasis. Intravenous jet or drip infusion of polyglucin 400-2000 ml is carried out, if indicated, blood transfusion, plasma, injection of 1 ml of 1% solution of morphine hydrochloride, 2% solution of pantopon, 1-2 ml of 10-20% solution of caffeine-sodium benzoate, 2 ml 1 % Lasix solution intramuscularly, intravenous administration of manniton - 200-500 ml of a 15% solution. In the first hours or days after the injury, compression of the spinal cord is eliminated. For this purpose, measures are taken to eliminate spinal deformity, reposition displaced vertebral fragments and immobilize them. From the very first hours it is necessary to monitor the function of the bladder and intestines (catheterization of the bladder with washing it with a 2% solution of boric acid, enemas). To prevent bedsores, sponge or pneumatic mattresses and regular wiping with camphor alcohol are recommended.
For spinal strokes, vasodilators and drugs that stimulate cardiovascular activity are prescribed (aminophylline 10 ml of a 2.4% solution intravenously, coplamin 2 ml of a 15% solution intramuscularly, cordiamin 1 ml subcutaneously or intramuscularly).
For circulatory disorders caused by compression of the spinal cord, for example, prolapse of a herniated intervertebral disc, surgical intervention is indicated.
Epidurit requires urgent surgical treatment.
In other cases, emergency care is determined by the nature of the underlying disease that caused leg paresis.
Emergency hospitalization for spinal cord injury in a neurosurgical hospital, urgent hospitalization for epiduritis.
In other cases, patients are hospitalized in the neurological department.
Spinal trauma is mechanical damage to the spine, most often it occurs as a result of impact, compression, or gunshot wound. If this injury is accompanied by damage to the spinal cord, the person may be completely or partially paralyzed for life or for a very long time.
If the cervical spine (and spinal cord) is affected, then paralysis of the arms and legs is possible; if the spine is injured below the cervical region, this can lead to paralysis of the legs (or the entire lower half of the body). The general rule in this case is this: in case of injury to the spine and spinal cord, all parts of the body that are located below the injury can fail.
The first and main consequence for the psyche of a person who has been injured and sat in a wheelchair for a long time is depression in the first time after leaving the hospital. There are three illusions in the subconscious of each of us: “This cannot happen to me,” “Everyone gets what they deserve,” and “I can defeat this.” After an injury, when the realization sets in that the body has become unhealthy forever, the entire worldview is turned upside down. Experts say that almost every second person who sat in a wheelchair tried to commit suicide after hospital. Depressed people lose sleep, appetite, interest in the world around them, tend to close themselves off from everyone, and can react aggressively to any manifestation of attention. This is fine.
Relatives and relatives of people who have received spinal disabilities should also take into account that sometimes after a lifelong injury a person develops victimization - the syndrome of “victim”, “deprived” and “victim”, which requires the whole world to pay some debt for her torment. You need to be tolerant of such manifestations and it is better to immediately contact a specialist psychologist or a rehabilitation center. The main thing that is required of family members and friends is to continue to show the person that he is needed, that his strength is needed in the household, that his wife and children still need his attention, support, and consolation.
Methods of movement with spinal injuries
Depending on the type of spinal lesion, there are several possible mobility options.
- Crutches - with preservation of the functions of the arms and legs, but weak muscles of the thighs.
- Wheelchairs and bicycle strollers - if hand function is preserved.
The wheelchair can be mechanical (the wheels are moved manually) or electric (powered by a battery or electric motor).
A bicycle stroller is a wheelchair to which another wheel with pedals has been added. It can be ridden by those who have at least one hand working. It is designed for outdoor travel over long distances. Operated using a lever.
- Wheelchair - if the function of the legs and arms is lost. In this case, the person is carried by an accompanying person.
Today in the Russian Federation there is a law according to which you can receive a stroller from the state for temporary use (usually for a period of 4 to 6 years). To do this, it is necessary to register a disability, undergo a medical examination and, based on its results, draw up an individual rehabilitation program (IPR). But many people prefer to buy more suitable strollers at their own expense. In this case, the state budget pays compensation - but only in the amount of payment for an ordinary state stroller.
Opportunity to get back on your feet
In some cases, it is possible to get back on your feet after using a stroller. Diagnosis of muscle function is carried out immediately after the injury - then the doctor will be able to give a preliminary prognosis regarding the ability to get back on your feet. But only preliminary - because there are cases where it was possible to restore sensitivity after a long time.
There are examples that refute the opinion of even the most authoritative doctors. The now famous author of rehabilitation methods, weightlifter Valentin Dikul, suffered a compression fracture of the lumbar spine after falling from a great height. His legs completely failed and he had to spend his entire life in a wheelchair. But he began to take care of himself: every day he did physical exercises for 5-6 hours, first developing what still worked, and then connecting the non-working organs. For example, he moved his legs that felt nothing with the help of ropes and counterweights. About seven years after the injury, Dikul had a terrible attack of pain. The temperature has risen. At first he didn’t feel anything, but after a week he realized that the thigh muscles that had once failed began to work. I felt pain from a needle prick in my leg. The spinal cord began to recover. After another two weeks, he began to walk with the help of two sticks.
Spinal injuries are one of the most severe types of injuries. Recently, the prevalence and severity of spinal column injuries has been increasing, which is associated with an increase in the amount of transport, traffic speed, the spread of high-rise construction and other factors in the modern way and rhythm of life.
Patients with spinal injuries make up 18% of all patients in trauma hospitals. These are mostly young people (average age is 17-35 years). Therefore, the treatment of spinal injuries is not only a responsible medical and social problem, but also an economic one, because the risk of developing permanent disability after spinal injury is very high.
The risk of disability after a spinal injury is very high
Among the causes of damage to the spinal column and the spinal cord, which is located inside, include:
The most common mechanisms of spinal injury
Injury to the spine and spinal cord has a clear classification, on which treatment tactics and prognosis directly depend. All injuries can be divided into open (with violation of the integrity of the skin) and closed (without them).
Depending on the nature of damage to the anatomical structures of the spine, there are:
All fractures are divided into 2 groups:
It is also important to divide spinal injuries into stable and unstable. Stable fractures occur when only the anterior part of the spine (vertebral bodies) is damaged. Moreover, if at the time of the blow the spinal cord was not damaged due to displacement of the vertebra, then in the future this risk is minimal.
Compression fracture of the spine
An unstable fracture occurs when both the anterior and posterior parts of the spine (arches and processes) are damaged simultaneously. Moreover, if compression of the spinal cord did not occur at the time of injury, then the high risk of this complication remains in the future, since any movement can lead to such consequences.
Types of spinal cord injuries:
The clinical symptoms of spinal injury primarily depend on whether the spinal cord is damaged, as well as on the location of the injury, its type and mechanism.
Stable spinal column injuries include:
Characteristic clinical symptoms:
Damage to the upper segments of the cervical spinal cord is life-threatening. The function of the cardiovascular and respiratory centers suffers, and this can lead to immediate death. If there is an injury at the level of the 3-4 segment of the spinal cord, the patient experiences tetraplegia (paralysis of the arms and legs), all types of sensitivity below the site of injury are lost. The respiratory muscles and diaphragm also suffer, which can lead to respiratory arrest.
MRI shows a fracture in the cervical spine and compression of the spinal cord
When the 4-5 segment of the spinal cord is compressed, tetraplegia occurs, but without respiratory disorders. If 5-8 segments of the spinal cord are damaged, paralysis of various arm muscles develops and lower paraparesis is observed; dysfunction of the pelvic organs may be present.
Damage to the thoracic spinal cord due to spinal injuries is accompanied by weakness in the legs and dysfunction of the genital and pelvic organs. Paralysis of the muscles of the anterior abdominal wall may occur. Respiratory disturbances may occur due to paralysis of the intercostal muscles.
Damage at the lumbar level leads to paralysis of various muscle groups of the lower extremities (foot, leg or thigh). Sensitivity below the location of the injury also suffers, and the function of the pelvic organs and reproductive system is impaired.
Diagnosis of injuries to the spine and spinal cord consists of interviewing the patient, clarifying complaints, the mechanism of injury, examination data of the person, determining the presence of neurological symptoms of spinal cord injury, as well as data from additional examination methods (radiography, MRI, CT, myelography, etc.).
Birth injuries are a whole group of mechanical damage to fetal tissue that occurs during childbirth. One of the most serious types of birth trauma is spinal injury. Recently, the number of such injuries has decreased significantly as the number of deliveries by caesarean section has increased.
Factors that can lead to birth injury to the spine:
Most often, the cervical spine and the adjacent brachial plexus are affected. Symptoms depend on the level of damage. As a rule, such an injury is accompanied by pain (the child is restless, constantly changes his position, testing physiological reflexes is painful). Torticollis, shortened or elongated neck may be observed. If the upper cervical segments of the spinal cord are damaged, a picture of spinal shock, various respiratory disorders, the “frog” position, and urinary retention or incontinence can be observed.
Obstetric care during childbirth can cause spinal injury
If the brachial plexus is damaged, the child may develop Cofferat syndrome (paresis of the phrenic nerve), Duchenne-Erb, Dejerine-Klumpke, and Kehrer palsy. All these syndromes have their own distinctive features and consequences.
Damage to the thoracic region is manifested by respiratory disorders resulting from paresis of the intercostal muscles, as well as lower paraparesis of the legs of a spastic nature, “flat belly” syndrome.
Trauma to the lumbar and sacral regions in infants is accompanied by flaccid paraparesis of the legs and dysfunction of the pelvic organs.
Recovery from a spinal injury in a newborn is long. In some cases, due to the high plasticity and degree of regeneration in infants, it is possible to completely get rid of the symptoms and consequences of injury, but in some cases persistent disability develops throughout subsequent life.
It is necessary to note 2 main points of care for spinal injury:
Transportation of a victim with a spinal injury
It is necessary to lay the victim on a hard surface with his back, and he is not allowed to sit down or stand up. Regardless of the damaged area, the cervical spine must be securely fixed. There are special collars for this. If you don’t have such a device at hand, you can roll up a thick roll of clothing and secure it around your neck.
Several people should carry the victim to keep the body at the same level and minimize movements in the spine. Such transportation will help avoid secondary spinal cord injury.
In this case, it is necessary to monitor the person’s pulse and breathing. In case of violations, resuscitation assistance must be provided according to the general rules. Under no circumstances leave the victim alone and do not move him from place to place unless absolutely necessary. It is imperative to call an ambulance.
The consequences of spinal injuries directly depend on the timeliness and correctness of first aid, on the type and mechanism of injury, and on concomitant damage to the spinal cord.
Treatment can be conservative or surgical. For mild injuries, treatment is only conservative. Prescribe symptomatic medications (analgesics, hemostatic, restorative, anti-inflammatory), strict bed rest, massage, exercise therapy, and physiotherapy.
In more severe cases, conservative treatment can be supplemented by closed reposition (simultaneous reduction of dislocations, fractures, traction) followed by immobilization of damaged segments of the spine (collars for the cervical spine, corsets for the thoracic or lumbar spine).
Exercise therapy is the main method of rehabilitation after spinal injuries
Surgical treatment is used in cases of spinal cord injury or high risk of injury due to spinal instability. Surgery may also be prescribed if conservative therapy is ineffective. After surgery, strict immobilization or traction is used.
Recovery from a spinal injury is a rather long and labor-intensive process. For injuries without compression of the spinal cord, exercise therapy is indicated from the first days of rehabilitation. They start with breathing exercises and gradually perform exercises for the limbs and spine. The classes must be supervised by a rehabilitation specialist. Massage and physiotherapy are also prescribed.
In case of spinal cord injuries, recovery is complemented by drug treatment, which is aimed at the regeneration of nervous tissue, electrical pulse therapy, and acupuncture.
Unfortunately, it is not always possible to restore functions lost due to spinal injury. But the desire to get better, as well as competent treatment and a rehabilitation program, sometimes work wonders.