cervical spinal cord injury
Introduction
Introduction to cervical spinal cord injury Injury of cervical spinal cord injury (injuryofcervical spinal cord) is a very serious injury, often resulting in death or disability. From the pathological changes of cervical spinal cord injury, it can be seen that cervical spinal cord injury is likely to lead to loss of limb function or even paraplegia. Once spinal cord injury occurs, it is necessary to find early treatment as soon as possible. basic knowledge Sickness ratio: 0.0001% Susceptible people: no special people Mode of infection: non-infectious Complications:
Cause
Causes of cervical spinal cord injury
(1) Causes of the disease
Cervical spinal cord injury is often associated with cervical spine injury, which can be divided into open injury and closed injury depending on the cause.
1. Closed injury: more common in normal times, due to external force, the cervical vertebrae have an over-flexion or over-extension activity, causing dislocation or fracture, indirectly causing spinal cord injury, mainly in work-related injuries, car accidents, sports accidents or birth injuries.
2. Open injury: more common in wartime firearms or sharp injuries, sharp injuries (such as knife stabs) due to the blocking of the lamina, the damage often tends to one side, causing half of the spinal cord injury, firearm injuries According to the relationship between the body path and the spinal cord, it can be divided into spinal canal penetrating injury, spinal canal blind tube injury, spinal canal tangential injury (more serious damage to the spinal cord and more, causing spinal cord fracture), vertebral body injury and paravertebral injury ( Indirect spinal cord injury, and partial spinal cord injury), firearm spinal cord injury, the degree of difference is very large, can be spinal concussion, contusion, hemorrhage, fracture compression until the spinal cord part or all of the fracture, open injury to the dura mater It is easy to cause meningitis or other soft tissue infections.
(two) pathogenesis
Similar to brain injury, it can be divided into two major categories:
1. Immediate pathological changes after injury
Immediately after the injury, the movement below the injury plane and the loss of sensory function occur, with the following pathological changes:
(1) Spinal cord turbulence: caused by temporary functional over-limit inhibition caused by violent shock of the spinal cord, but its appearance does not seem to change, the clinical manifestation is spinal shock, and its symptoms and spinal cord are completely difficult to distinguish, but can be several days. Or fully recovered after 3 to 4 weeks.
(2) Spinal contusion: often caused by foreign body, fracture piece, dislocation vertebral body directly damage the spinal cord, causing contusion or transverse injury, edema of the injured spinal cord tissue, hemorrhage or softening necrosis, partial or total loss of spinal cord function.
(3) Spinal compression: fractures that protrude into the spinal canal, displaced vertebral bodies, and intervertebral discs can be squeezed into the spinal cord to cause congestion, ischemia, edema or softening and necrosis. If it can be detected early, timely surgery to relieve compression, Limb function can be quickly restored, such as too long extrusion time, it is not easy to recover.
2. Delayed pathological changes after injury
At the beginning of the injury, the neurological symptoms are still mild, and gradually worsened later. The pathological changes are as follows:
(1) intraspinal hemorrhage: injury caused by small blood vessels in the spinal cord rupture and hematoma formation, mainly in the blood vessels rich in the cervical cord gray matter, small hematoma can be absorbed, large hematoma can spread up and down several segments, if the bulge is important The center of life (breathing, circulation) can cause death.
(2) Spinal cord edema: edema of the spinal cord tissue in the injured area, due to local deformity caused by crush fracture, can affect the blood supply to make the edema worse.
Prevention
Cervical spinal cord injury prevention
There is no preventive measure for cervical spinal cord injury. Early detection and early diagnosis are the key to the prevention and treatment of this disease. The choice of daily dietary intake should be high fiber, low fat, low cholesterol diet and calorie adjustment, in order to reduce blood glyceryl triglyceride and neutral fat mass, in order to achieve weight control and long-term rehabilitation Energy consumption.
Complication
Cervical spinal cord injury complications Complications
1. Respiratory movement disorder:
When the upper cervical spinal cord is injured, the diaphragm and intercostal tendon can often occur, resulting in respiratory dyskinesia, and the patient can quickly die due to difficulty in breathing.
2. Meningeal infection:
The open spinal cord injury causes the dura mater to penetrate and communicate with the outside world, which can easily cause meningitis or other soft tissue infections.
Symptom
Cervical spinal cord injury symptoms Common symptoms Difficulty paraplegia Edema coma Sphincter dysfunction Quadriplegia Spinal cord hemorrhage Cervical spinal nerve root damage Cervical fracture and dislocation
Depending on the extent and location of the injury.
1. Upper cervical spinal cord injury: It is prone to quadriplegia. If the diaphragm and intercostal muscle spasm, breathing difficulties may occur, often leading to rapid death.
2. Spinal cord injury in the lower neck: limb paralysis occurs below the injury plane, and the upper limb is segmental sensation and movement disorder. Due to thoracic respiratory tendon, the patient has only abdominal breathing, accompanied by sphincter dysfunction and Horner syndrome.
3. Complete rupture of the spinal cord: flaccid complete paralysis can occur immediately, and various sensations and reflexes below the damage plane disappear, and generally cannot be recovered.
4. Partial injury may also appear as a complete paraplegia as severe as complete fracture, or with spinal cord hemorrhage, edema development, symptoms gradually worsened within a few days, such as only spinal cord concussion, usually within days or weeks, Spinal cord function can be gradually restored.
When the injury is limited to the half of the spinal cord, Brown-Sequard syndrome may occur, that is, dyskinesia occurs on the injured side, and pain and temperature sensation are present on the contralateral side.
Examine
Examination of cervical spinal cord injury
1.X-ray film:
Can show cervical fracture and dislocation, joint lock, foreign body and fracture piece compression and intervertebral space stenosis, etc., to help determine the nature and extent of spinal cord injury, but be especially careful not to make the cervical spine twist, resulting in increased spinal cord injury, X-ray Normal neck can not completely rule out cervical spinal cord injury.
2. CT scan:
The display of the bone structure is clearer than the MRI, which not only can be found in fractures, dislocations, but also shows deformation of the spinal canal and spinal cord compression.
3.MRI:
The display of the spinal cord and intervertebral disc is superior to CT. The sagittal plane can directly observe the extent and extent of spinal cord injury, as well as the presence or absence of intraspinal hematoma, especially chronic spinal cord injury, which is significantly better than CT scan.
4. Lumbar puncture and cerebrospinal fluid dynamics test:
Sometimes bloody cerebrospinal fluid can be found in the waist.
5. Pressure neck test:
If the paraplegia gradually appears or is aggravated after the injury, if necessary, the lumbar puncture and neck compression test should be performed as soon as possible to obtain the basis of subarachnoid obstruction.
6. Spinal cavity iodine angiography:
Can understand the subarachnoid obstruction or deformation, such as combined with CT scan is more diagnostic value.
Diagnosis
Diagnosis and diagnosis of cervical spinal cord injury
1. History: history of neck trauma with dislocation or fracture of the cervical spine.
2. Clinical symptoms and signs: Abnormal respiratory morphology and/or dyspnea; limb paresthesia, limb dyskinesia; pathological reflex exists.
3. Imaging diagnosis.
To comprehensively check whether the wounded have a shock, coma, neck blood vessels, trachea, craniocerebral, chest and abdomen organs combined injury, according to the injury, must be treated first, local examination to pay attention to the presence of deformity, tenderness, swelling, tendon, Hematoma, open injury, attention to the direction and location of the wound, whether there is cerebrospinal fluid or foreign body retention.
