Sometimes the disease remains unrecognized due to minor clinical manifestations. However, the consequences of a fracture of the spine can develop both immediately after the injury and after a long time, causing anatomical and functional disorders at the site of the pathology. It is therefore extremely important to consult a doctor for diagnosis and timely treatment to prevent long-term complications of spinal cord injuries.
The essence of the fracture mechanism of the spine is the impact of a force that exceeds the safety margin of bones. In a healthy body, the bone tissue is firm and elastic, it requires the influence of high intensity force to damage it. In children and young age, spinal column injuries occur when falling from a height above their own growth, as a result of direct impacts on the body, sharp tilts or turns of the trunk, car accidents.
In some cases, fractures appear with the influence of a minor force of the traumatizing agent due to the weakening of the strength of the vertebrae. This occurs in the case of the formation of osteoporosis( depression of bones), endocrine pathology, metabolic disorders, tumor processes in the vertebrae. The most common pathology occurs in people in old age due to involutive processes in tissues, post-menopausal changes in women, metastases of malignant neoplasms in the spinal column.
Consequences of spine injury
As a result of the influence of the traumatic factor, there are sharp pains in the area of damage that increase during movement. Also, visualized deformity of the spinal column, swollen soft tissues of the back, wounds, sometimes accompanied by bleeding may appear. Depending on the location of the injury, the pain syndrome can spread to the hands if the cervical region is damaged or the legs are damaged due to the vertebrae in the lumbar region.
Vertebral instability: a schematic image, radiograph and tomogram appearance( from left to right)
Vertebral fractures, altered due to a particular disease, occur with a weak action of the traumatic agent and often show slight discomfort in the back. Malosymptomnoe flow is typical for damage to the spinous and transverse processes. With violation of the integrity of the spinal cord and spinal nerves, neurological symptoms of varying severity arise. The consequences of vertebral fracture include instability of the injured vertebrae, nonphysiological kyphosis and neurologic changes.
Vertebrae are interconnected by intervertebral cartilage, joints between the processes, muscles, ligamentous apparatus and form the motor vertebral segment, which allows the axial skeleton to function normally. If one, and sometimes several components of the spinal column are damaged, the segment is loosened and its hypermobility is formed - the ability to non-physiological movements.
Most often, this pathology is formed with compression fractures of the third degree. As a result, posttraumatic osteochondrosis( degenerative change of intervertebral cartilage interlayers in the lesion site), infringement of the spinal roots( radicular syndrome), chronic discomfort in the back area develops, which reduces tolerance to daily physical activity. Quite often there are protrusions, hernia, proliferation of bone tissue in the form of osteophytes.
Pathological spine kyphosis
A healthy vertebral column has a physiological bend back in the thoracic part, which does not exceed 40 degrees. Due to fractures of the vertebrae, the bending of the spine becomes more normal, which causes the formation of a pathological kyphosis or hump. The disease often develops in elderly patients or as a result of osteoporosis in the case of repeated compression injuries of the thoracic spine. At the same time, the disease usually goes through a low symptom and remains without the necessary medical care. Curvature of the spinal column causes a pathological spasm of the muscles of the back, which is manifested by regular pain and discomfort. In addition, pathology causes a change in the anatomically correct structure of the chest and disrupts the lungs, heart, stomach, and liver.
Changes in the nervous system occur when the integrity of the nerves and spinal cord, which usually develop with fragmentation and displaced fractures of the axial skeleton, is disturbed. Nervous tissue can undergo bruising, crushing, shaking, crushing or transverse rupture. Such damage gives a clinical picture soon after the injury, manifested by the pathology of the motor, as well as the sensitive sphere below the defect site. Fractures of the lumbar vertebrae and in the lower part of the thoracic region cause paralysis, plethysmia, hypodesa in the legs, violation of defecation and urinary excretion, and changes in the upper parts of the breast - disruption of the muscles located in the back and abdomen.
Comparison of the appearance of the healthy spine and non-physiological kyphosis
The most dangerous injuries of the cervical spine. Defects of the spinal cord in this area entails complete immobilization, disruption of the respiratory and diaphragmatic muscles, stopping respiratory activity, which can cause the onset of death. Damage of the 1st or 2nd cervical vertebra causes a lethal outcome, but is extremely rare. After a fracture, in most cases a severe disability occurs, which is accompanied by an inability to perform basic movements, self-service, and sometimes requires the maintenance of breathing by artificial ventilation.
Long-term neurologic effects can also be formed in the weeks and months following the trauma. They are associated with the occlusion of feeding arterial vessels as a result of a decrease in the spinal canal with bone processes. Progression of the pathological process causes a serious disease of the spinal cord tissue - myelopathy, which leads to a decrease in muscle strength, pathology of the internal organs, a change in the motor ability and the sensitive sphere of the controlled parts of the body.
Fractures with damage to the spinal cord tissue
An adverse effect of changes in the anatomical structure of the vertebrae is a violation of the integrity of the spinal cord of varying severity, which usually develops during compression fractures. Such injuries can cause a threat to life and affect the formation of the 1st degree of disability - a significant immobilization of the body, leading to loss of efficiency, self-service, normal motor activity. Soon after a trauma of a nervous tissue the serious condition of an organism - a spinal shock develops. It is characterized by inhibition of the function of movement, various types of sensitivity, reflex activity of the cells of the spinal cord. The shock usually lasts for several weeks or months, but appears with defects of the cervical and upper thoracic spine. Changes in the so-called ponytail, which is located in the lumbar region, affect the functions of organs located in the small pelvis( not holding the urine and feces) while maintaining the ability to move.
Fracture of the spine with a defect in the spinal cord tissue in the image during computed tomography
The mechanism of the pathological process consists in stopping the conduction of nerve impulses from healthy neurons into damaged cells. This disrupts the central nervous system's control function in parts of the body located below the fracture site. Of the common symptoms, there is a decrease in blood pressure, slowing of the pulse, violation of thermoregulation, which causes a drop in body temperature below the site of injury.
Neurological manifestations are accompanied by signs of a physiological transverse rupture of the spinal cord: a decrease in muscle tone, fading of reflexes, lack of sensitivity and motor activity. As treatment and rehabilitation are carried out, the lost functions can be restored in full.
With an anatomical rupture of the spinal cord, pathological changes are quite persistent and even after the operation they do not return to their previous condition.
Diagnostics and treatment measures
After an injury of the spine, an instrumental examination is prescribed, which includes radiography, computer and nuclear magnetic tomography. Thanks to diagnostics, they detect defects in bone tissue, vessels, nerves, muscles and spinal cord. After the diagnosis is established, conservative therapy is performed, or surgical intervention is recommended, according to the severity of the pathology. It should be remembered that the earlier the treatment and rehabilitation is carried out, the better the prognosis of spine injury.
After admission to the hospital, prescribe analgesics( renalgans, dexalgins) to eliminate the pain syndrome, vitamins and calcium preparations to improve healing. With a defect in the spinal cord, drugs that improve nerve tissue trophism( pentoxifylline) are recommended. In nutrition, they organize an increased content of dairy products, nuts, green vegetables, dried fruits.
Surgical restoration of the vertebral column fracture by means of pins
Assign bed rest for the first 7 days after injury, then gradually increase motor activity. Before the growth of bone defects, patients wear special corsets, belts, collars to immobilize the injury site and limit active movements. Uncomplicated fractures in adults heal within 3 to 4 months, in children for 1.5-2 months. Combined injuries and defects of the spinal cord are consolidated throughout the year.
In severe injuries of the spine, an operation is performed to remove the fragments, decompress the nervous tissue and vessels. The destroyed vertebrae are replaced with autotransplants( their own tissue) or artificial prostheses. After the healing of the fracture, rehabilitation measures are carried out using physiotherapy, massage, and physical therapy. Incorrect therapy and rehabilitation contribute to the formation of undesirable consequences of spinal cord injury.
Fracture of the spine in medical practice refers to a serious injury, which often causes the formation of disability and death. Prevention of injuries, timely diagnostic measures and complex therapy contribute to improving the prognosis of pathology for recovery and life.