Spine, Spinal Cord Injury
Introduction
Introduction to spinal and spinal cord injury Spinal cord injury often occurs in industrial and mining, traffic accidents, wartime and natural disasters can occur in batches. The injury is serious and complicated, with multiple injuries, multiple injuries, and many complications. The prognosis is poor when combined with spinal cord injury, and even life-long disability or life-threatening. basic knowledge The proportion of illness: 0.015% Susceptible people: no specific population Mode of infection: non-infectious Complications: Acne Respiratory infections Stress ulcers Thrombosis Upper gastrointestinal bleeding
Cause
Causes of spinal and spinal cord injury
Spinal fracture classification:
1. According to the direction of violence during injury, it can be divided into: flexion type, straightening type, flexion rotation type and vertical compression type.
2, according to the stability after fracture, can be divided into: stable and unstable.
3, Armstrong-Denis classification: is a common classification at home and abroad, a total of: compression fractures, burst fractures, posterior column fractures, fracture dislocation, rotational injury, compression fracture combined with post-column fracture, burst fracture combined post-column fracture.
4, according to the classification: can be divided into cervical vertebrae, thoracic vertebrae, lumbar vertebrae fracture or dislocation, according to the vertebral anatomy can be divided into vertebral body, vertebral arch, lamina, transverse process, spinous process fracture.
5, traumatic fracture-free dislocation type of spinal cord injury, mostly in children and middle-aged and elderly patients, characterized by imaging examination without fracture and dislocation.
Pathology and type of spinal cord injury:
1. Spinal cord injury In the early stage of spinal cord injury, spinal cord shock is often accompanied by sensation, movement, and complete loss of sphincter function. The spinal cord shock can recover spontaneously within a few weeks. The appearance of corpus cavernosum or the appearance of deep sacral reflex is Sign of spinal cord termination.
2, spinal cord contusion can be mild hemorrhage and edema, or the spinal cord can be completely frustrated or broken, cystic changes or atrophy can occur later.
3, spinal cord compression due to the insertion of the vertebral canal, vertebral body, intervertebral disc and other tissues directly compress the spinal cord, resulting in bleeding, edema, ischemic degeneration and other changes.
The clinical manifestations of spinal cord injury caused by the above pathology may be complete or not, depending on the degree of injury.
Prevention
Spinal and spinal cord injury prevention
The disease is caused by traumatic factors, so there is no effective preventive measures, pay attention to the safety of production and life, and avoid the key to the prevention and treatment of this disease.
For patients with surgical treatment, the prevention of complications should be actively prevented. It is also necessary to pay attention to early functional exercise. It can be started from passive exercise and gradually replaced with active exercise to promote the best condition of the limbs and improve the quality of life after rehabilitation.
Complication
Spinal and spinal cord injury complications Complications, acne, respiratory tract infection, stress ulcer, thrombosis, upper gastrointestinal bleeding
Patients with this disease may have the following complications due to their weak body resistance and the inability to get out of bed.
1, hemorrhoids, which is caused by local long-term compression, resulting in blood circulation disorders.
2, urinary tract infection, spinal cord injury patients due to long-term stimulation of the indwelling urinary catheter, resulting in decreased bladder defense mechanism, the infection rate is quite high.
3, joint stiffness and deformity.
4. Prevention and treatment of respiratory infections.
5, autonomic nervous system dysfunction.
6, will secrete.
7, stress ulcers, mostly occurred in patients with large trauma, due to large stimulation, may cause changes in autonomic nerve function, digestive dysfunction, and gastric and duodenal stress ulcers, upper gastrointestinal bleeding.
8, lower extremity venous thrombosis, the patient's blood is hypercoagulable after trauma, venous return is slow, long-term bed rest is easy to cause lower extremity venous thrombosis.
Symptom
Spinal and spinal cord injury symptoms Common symptoms Tension fatigue Abdominal pain Intestinal peristalsis Slowing spinal shock Abdominal distension Paralysis Constipation Urinary incontinence Sensory disorder Reflex hyperactivity
Spinal fracture
1. There is a history of serious trauma, such as falling at high altitude, heavy objects hitting the neck or shoulders, landslide accidents, traffic accidents, etc.
2, the patient feels local pain, neck movement disorder, waist and back muscle spasm, can not stand up and stand up, local fractures can be limited and limited kyphosis.
3, due to retroperitoneal hematoma on the autonomic nerve stimulation, intestinal peristalsis slowed down, often abdominal distension, abdominal pain and other symptoms, sometimes need to be differentiated from abdominal organ damage.
Combined spinal cord and nerve root injury
After spinal cord injury, movement, sensation, reflexes, and sphincter and autonomic nerve function are impaired below the injury plane.
1, feeling the obstacle
Pain, temperature, touch and body sensation below the damage plane weaken or disappear.
2, movement disorders
In the spinal cord shock stage, the spinal cord injury segment is characterized by soft palate, and the reflex disappears. If the spinal cord transverse injury occurs after the shock period, the upper motor neuron spasm, the muscle tension is increased, the tendon reflex is increased, and the sputum and sputum are present. Pathological reflex.
3. Sphincter dysfunction
The spinal cord shock period is characterized by urinary retention, and the bladder detrusor palsy forms a tension-free bladder. After the shock period, if the spinal cord injury is above the plane of the palpebral medulla, the auto-reflex bladder can be formed, and the residual urine is less than 100ml, but not free. Urination, if the plane of the spinal cord injury is damaged in the conus or sacral nerve root of the cone, urinary incontinence occurs. The emptying of the bladder requires emptying the abdominal pressure (using the abdomen by hand) or using a catheter to empty the urine. Constipation and incontinence also occur in stools.
4, incomplete spinal cord injury
In the distal plane of the injury plane, the movement or sensation of the spinal cord is still called incomplete spinal cord injury. There are several types of clinically:
(1) Anterior spinal cord injury: manifested as autonomous movement and pain sensation below the injury plane. Because the posterior column of the spinal cord is not damaged, the patient's sense of touch, position, vibration, movement and deep pressure are intact.
(2) central spinal cord injury: more common in cervical spinal cord injury, showing upper limb movement loss, but the lower extremity motor function or upper limb motor function loss is significantly more serious than the lower limb, the sacral reflex of the injury plane disappears and the sacral reflex below the damage plane .
(3) Brown-Sequards Symdrome: The contralateral pain temperature below the lesion plane disappeared, the ipsilateral motor function, positional sense, motor sensation and two-point discrimination loss.
(4) Posterior spinal cord injury: the deep sensation below the injury plane, deep pressure sensation, loss of positional sensation, and painful temperature and motor function are completely normal, more common in patients with laminar fractures.
Examine
Examination of spinal and spinal cord injuries
The auxiliary examination methods for this disease are as follows:
X-ray examination
Routine lateral position of the spine, if necessary, oblique position, the height of the anterior and posterior vertebral bodies measured compared with the upper and lower adjacent vertebrae when reading the film; measuring the pedicle spacing and vertebral body width; measuring the spine spacing and intervertebral disc space The width is compared with the upper and lower adjacent intervertebral space, and the height of the pedicle on the positive side is measured. The X-ray can basically determine the location and type of the fracture.
2. CT examination
It is beneficial to determine the degree of invasion of the spinal canal by the displaced fracture block and to find the bone or intervertebral disc that protrudes into the spinal canal.
3. MRI (magnetic resonance) examination
It is extremely valuable for determining the condition of spinal cord injury. MRI can show edema and hemorrhage in the early stage of spinal cord injury, and can show various pathological changes of spinal cord injury, spinal cord compression, spinal cord transection, spinal cord incomplete injury, spinal cord atrophy or cystic change. Wait.
4. SEP (somatosensory evoked potential)
It is a method for measuring the conduction function of the somatosensory system (mainly after the spinal cord), and it is helpful for determining the degree of spinal cord injury. MEP (sports inducing potential) is now available.
5. Jugular vein compression test and myelography
The jugular vein compression test has certain reference significance for determining spinal cord injury and compression. Myelography is meaningful for the diagnosis of old traumatic spinal stenosis.
Diagnosis
Diagnosis of spinal and spinal cord injury
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
Because of the disease, the retroperitoneal hematoma stimulates autonomic nerves, slows intestinal peristalsis, and often causes abdominal distension, abdominal pain and other symptoms. Sometimes it needs to be differentiated from abdominal organ injury. In addition, it is necessary to pay attention to spinal fracture and dislocation, burst fracture, and spinal cord edema. The probability of hemorrhage and rupture is high. The probability of spinal cord injury is low in simple compression fractures, but there are still spinal cord injuries. Even some spine has no spinal fractures, so when the clinical symptoms are severe but X-ray, CT examination If they do not match, an MR I examination should be performed in time to observe the spinal cord condition.
