- Mechanism of the appearance of pathology
- Clinical picture
- Periods of the course of the pathology
- Therapeutic tactic
Spinal shock is a pathological condition that occurs after a spinal cord injury. It is caused by the braking effect of the brain on the areas of the nervous tissue below the site of damage, can be reversible and irreversible. The severity of the course of the shock depends on the level of damage to the spinal cord and the impact of the traumatizing agent.
Mechanism of the appearance of the pathology
Spinal shock develops due to a strong blow to the body with a blunt object, after falling on the back from a height or traffic accidents. A rupture of the spinal cord can occur as a result of knife and gunshot wounds. However, the most frequent cause of damage to the spinal cord tissue is vertebral fracture. At the same time, disturbances occur not only at the site of the impact of the traumatic force, but also in the area of circulatory disturbance and outflow of lymph. Thus, at the beginning of the development of pathology the area of damage is much broader, but usually is reversible.
After spinal cord injury, protective physiological mechanisms develop, which consist in inhibition of nerve cells located below the site of injury. This is necessary to reduce the functional activity of deformed tissues and to maximize the restoration of disturbed structures.
This condition is clinically expressed in the absence of reflexes, complete immobilization, loss of all kinds of sensitivity, disruption of the pelvic organs. Immediately after the injury, flaccid paresis and paralysis develop with a low tone of the limb muscles. Over time, motor disorders take a spastic character with a high muscle tone.
Localization of motor and sensory disorders depending on the level of spinal cord injury
The mechanism of shock development is characterized by a violation of the conductive pathways of nerve impulse transmission, which ensures the absence of functional activity of the spinal cord below the injury site. However, the spinal cord rupture can be both anatomical and functional, which in the first days after the injury can not be determined from the clinical picture. The anatomical rupture subsequently gives a persistent picture of neurologic disorders, and the functional discontinuity tends to complete or partial restoration of lost functions.
Clinical manifestations of the disease depend on the level of damage to the spinal cord. The higher the anatomical or functional rupture of the nervous tissue, the heavier the neurological symptoms and the more unfavorable the prognosis for recovery. The most serious consequences occur with damage to the cervical spinal cord.
Trauma at the level of the neck segments C1-C4 leads to paralysis of the upper and lower extremities, the loss of tendon reflexes and sensitivity, incontinence of urine and feces. In addition, the function of respiration and cardiac function suffers. Patients can not breathe independently due to a violation of the innervation of the diaphragm and are forced to constantly be on artificial ventilation. Severe disability can not be realized in domestic and professional activities. For the elementary skills of self-service are not available for patients.
Consequences of spinal shock can lead to disability
The defeat at the level of the cervical segments of C5-C7 partially preserves the movement of the upper limbs - flexion and extension at the elbow joint, the operation of the fingers. Damage of the thoracic spinal cord leaves normal functioning of the hands, but it affects the disruptions of the respiration and cardiac activity due to violation of the innervation of the intercostal and abdominal muscles. Problems with breathing occur with trauma at the Th3-Th7 level, damage in the lower thoracic parts of Th8-Th12 causes paralysis of the muscular corset of the back, lower limbs and disruption of the pelvic organs in the form of impotence, incontinence of urine and urine.
Least severe consequences develop with spinal shock at the level of the lumbosacral segments of the spinal cord. In this case, certain types of sensitivity are retained, paralysis or paresis of only the lower extremities occurs. Such patients are able to move in a wheelchair, with the help of walkers or crutches, have skills of self-service and can be realized in professional activities.
pathology The spinal cord shock is reversible or partially reversible. After the restoration of the damaged nervous tissue, the lost functions are usually returned within a few months. Depending on the degree of reparative processes and symptoms of the disease, the following are identified:
Damage to the spinal cord is detected in the computed tomography
- - the first 3-4 days after the impact of the traumatic factor, characterized by complete cessation of nerve impulses, lack of reflexes, sensitivity and motoractivity regardless of the severity of the damage;
- subacute period - continues for 2-4 weeks, characterized by the restoration of damaged structures of the spinal cord, the appearance of scar changes in the defect site, the return of the physiology of healthy cells of the nervous tissue, normalization of blood circulation, lymph drainage, movement of cerebrospinal fluid( cerebrospinal fluid);
- interim period - continues for 3-6 months, is characterized by the elimination of central inhibition of the spinal cord below the site of damage, the real consequences of trauma, the lost functions are restored, and irreversible neurologic changes appear.
It should be remembered that a complete lack of motor, sensitive, reflex activity below the injury site in the first week after injury is a poor prognostic sign. On the contrary, even a slight decrease in motor and sensitive disorders gives hope for the restoration of lost functions.
The effectiveness of spinal shock treatment depends largely on the timeliness of therapeutic measures. The correct provision of first aid is of no small importance. After a spinal cord injury, the victim is urgently taken to the neurosurgical department. It is necessary to move the patient on a firm surface, in order not to aggravate the damage to the spinal cord. It is better to wait for the ambulance. Before the arrival of physicians, one should monitor the breathing of the victim, prevent the violation of the patency of the airways - clean the mouth of the vomit, do not allow the tongue to become tongue-tied.
In the conditions of a specialized hospital immobilization of the spine is carried out. Assign surgery for decompression of the spinal cord. Remove bruises, fragments of bone tissue, conduct plastics of the spinal column. Conservative therapy includes the appointment of glucocorticoids( dexamethasone, prednisalone) to reduce edema of the nervous tissue, reduce the inflammatory response in the area of damage and eliminate pain syndrome. Pathological spasticity of muscles requires the appointment of muscle relaxants with a central mechanism of action( sirdalud, baclofen, midokalm).
Spinal cord decompression by surgery prevents the development of disability
Prophylaxis of pressure sores, precessional massage and respiratory gymnastics for the prevention of congestive pneumonia. In the interim period, rehabilitation measures are applied with the help of physiotherapy, mechanotherapy, and physical therapy in order to restore lost functions.
For a patient after a spinal injury, it is important not only physical rehabilitation, but also psychological help. The process of restoring motor functions is slow, some neurological disorders are not reversed. It is necessary to help a person correctly assess their physical condition, adapt to society and be realized in all spheres of life. The rehabilitation period is no less important than treatment, and can solve many problems at the physiological and psychological levels.
Spinal shock refers to a severe pathological condition that occurs in response to a spinal cord injury. The severity of the consequences and the degree of disability depends on the level of damage and the timely conduct of comprehensive treatment. In most clinical cases, neurologic disorders are reversible, which gives a chance for a complete or partial recovery of motor activity, sensitivity and pelvic organs.