Pathology of spinal injury

2021-01-30 12:00 AM

For the most dorsal segments, the transverse segmentation of the fourth spinal cord is very poor, the lesions here are very serious.

Outline

Spinal injuries generally account for about 4-6% of all injuries. In fact, the examination of trauma to the spine is an examination of lesions in the vertebra, disc, ligaments. The spinal cord is the part of the spinal canal that often suffers from indirect trauma due to the damage to the spine mentioned above.

Causes, mechanism of location of injury

Reason

Spinal injuries are often caused by traffic accidents, falling from above, tunnel collapses, fighting and accidents in sports, such as motor racing, cars ...

Mechanism

In spinal trauma there are two prominent mechanisms, the direct mechanism and the indirect mechanism.

Direct mechanism: being hit by a hard object directly on the spine, or falling, making the spine too stretch or flex.

Indirect mechanism: Squeezing along the spine from top to bottom or from bottom up. For example, falling from above to turn head down first, objects falling from above on shoulder blades, falling sitting. The mechanism of indirect trauma is also mentioned in the case of excessive spinal rotation or distortion.

Lesions sites

It can be found anywhere on the spine but is common in weak spots where the junction between the movable vertebrae and the less mobile vertebrae such as D12 - L1 and C5 - C6. Usually a single vertebra is injured, but sometimes 2 - 3 vertebrae are adjacent or not.

Pathology and pathophysiology

Pathology

Broken vertebrae

Often it is a displaced vertebral body with fragments causing damage to the marrow tissue.

Dislocations of the spine

Or occurs in the cervical spine and lumbar transition, the result is that the spinal canal is much narrowed, causing the spinal tissue to collapse. Spinal dislocations also cause damage to nerve roots, in the disc, ligaments behind the vertebral body such as the spinal ligament, the arteries and the spinal veins.

Lesions to the marrow tissue

Myeloid tissue injuries due to myeloid tissue necrosis due to local anemia and hematoma in the myeloid tissue. For the most dorsal segments, the transverse segmentation of the fourth spinal cord is very poor circulation here. The lesions are very serious.

Epidural hematoma

Extracellular hematoma is very rare, for the marrow, secondary lesions such as hematoma are rare, but even in trauma, there are often damage to the marrow tissue such as trauma, stamping the pulp.

Pathophysiology

The phenomenon of marrow edema appeared immediately after trauma in the marrow in addition to the phenomenon of spasm of the arteries, capillaries. According to the theory of myeloid tissue cannot tolerate hypoxia for more than 6 hours. Therefore, the compression and anemia in the marrow tissue over time can easily leave sequelae.

Spinal shock occurs shortly after spinal collisions, manifested by a complete suspension of centrifugal and afferent functions from the site of the injury downwards. Pulmonary shock lasts from a few days to 6 weeks.

Classification of lesions

Based on the type of injury it is divided:

Spinal injuries do not have marrow lesions

Includes vertebral injuries such as spina bifida fracture, spondylolisthesis fracture. Disc damage, damage to ligaments such as stretch ligaments, ruptured ligaments of the posterior spine, anterior and posterior ligament of the spine.

Spinal injuries with marrow lesions

These include spinal cord concussion, pulp suppression, bleeding in the marrow, damage to the anterior part of the pulp, damage to the pony tail.

Spinal cord injury but no spinal damage

This is a paradoxical condition, with severe damage to the actual marrow, but no spinal damage.

In addition to the above 3 ways, spinal injuries are also divided into 2 categories:

Firm Fractures: A collapsed fracture or fracture of the vertebral body, but no vertebral displacement. The posterior spinal ligament may not rupture, not cause joint joints.

Unstable fracture: is a fracture of the vertebra with dislocation, rupture of the displaced vertebral joint, rupture of the ligaments.

Clinical and subclinical symptoms

Clinical symptoms

Clinical symptoms of spinal injury without marrow injury

Pain: Localized pain in the affected vertebra, with a throbbing pain spot in place.

Restriction of movement: The patient often hurts when walking, lying down to rest to help in case of a steady fracture.

Spinal deformity: Sometimes the patient on the side can see the deformity of the spine slightly backward, looking bruised and swollen in place, if the spine of the neck is damaged, the neck will be limited in movement and double when looking short.

Clinical symptoms of spinal injury with spinal cord paralysis

Systemic symptoms: Depending on the location and extent of the marrow damaged or whether there was a combined damage.

Perceptual: May be perceptual disturbances in cervical spinal injury with marrow injury.

Respiratory: Respiratory disorder is encountered in trauma to the cervical spine from C1 to C5 because it directly affects the respiratory center of the medulla. Difficult breathing disease, slow breathing 15-20 times / minute, most can die. The pulse is usually slow 50-60 times / minute and blood pressure drop due to myelosuppression. In trauma to the cervical spine from C1 - C5, it can be seen that the body temperature drops as low as 35-360 due to disturbance of the vasomotor center, in the thermostat zone.

Neurological symptoms

In the stage of myelosuppression, clinical manifestations of marrow injury are loss of movement, soft paralysis, loss of all reflexes, sensations from the lesion down, sphincter disorders with urinary retention and defecation.

Damage to the cervical spine from C1 to C4: L is the serious injury that often leads to death. Stage of myelosuppression: soft paralysis and peripheral paralysis of extremities present with severe cardiovascular and respiratory disturbances, speech difficulty and swallowing difficulty. After stage myelosuppression increases muscle tone, increases tendon reflexes and auto-marrow reflex.

Injury from C5 - D1: The stage of soft spinal shock, quadriplegic paralysis, post-myeloid shock increases tendon reflexes and auto-marrow.

Lesions from D2 - D10: The stage of shock of the spinal soft paralysis of the legs, loss of all kinds of sensations (pain, delicate touch) from the lesion down. The site of the loss of pain is significant for a definitive diagnosis of the affected vertebrae. For example, the loss of pain from intercostal 4 is due to damage to the medullary segment D5 corresponding to the vertebra D3. After stage myelosuppression increases tendon reflexes and auto-marrow reflexes.

Injury from D11 - L1: The stage of shock is spinal soft paralysis with two legs, abdominal distension due to functional intestinal paralysis, easy to confuse with surgical abdomen. Loss of pain from across the groin. Post-stage paralysis of two legs. The legs have quickly contracted.

Injury from L2 - same 1: complete horsetail syndrome: paralysis of two legs, rapid atrophy of the legs, loss of feeling of groin and perineum. Or may present incomplete horsetail syndrome: peripheral incomplete paralysis of two legs, the patient may bend thighs into the abdomen and lose feeling of the perineum, anus, and genitals.

Distinguish between complete paralysis and incomplete paralysis

It takes 1-3 weeks to differentiate.

Complete paralysis

The lower limb contraction reflex clearly.

Erect the penis often.

Complete loss of nerve signs and no recovery.

Paralysis is not complete

The lower limb contraction reflex is mild and slow.

No complete loss of nerve signs and gradual recovery.

Some of the symptoms identify the injured marrow area

Normal motor limbs: No serious damage to the spinal cord.

The two lower extremities were paralyzed with damage from the spine down.

Quadratic extremities: Damage to the cervical spine.

Bailav's paralysis postures:

Upper limbs are high on head, elbows folded, forearms rested halfway in the injury C6.

The limbs on the elbows are folded to the chest edge, the fingers are folded halfway in the C7 lesion.

The upper limbs were completely paralyzed like death lying along the body in C5 lesion.

Subclinical

Photograph of the spine straight and tilted depending on the location of the lesion in the clinical setting to determine the spinal fracture (fracture of the body, fracture of the transverse crown, the crown of the spine), slip of the spine, and collapse of the spine.

Computer tomography, magnetic resonance imaging (IRM): To detect spinal cord injuries.

The principles of treatment

Depends on the type and type of fracture:

In cases of steady fracture (type 1) medical treatment and supine position on hard bed. Strengthen the brace or cast when walking, if not paralyzed.

Surgical repair of the fracture with a bone graft or scissors.

According to Laminectomies, the compression of the marrow is released in cases of unstable fractures and suppression of myeloid edema.

Motor rehabilitation is an important stage in spinal injuries with spinal cord paralysis.

Preventive

Propaganda and community education on traffic law.

Introduced into the grassroots traffic law curriculum

Well implementing the labour safety law in production facilities and construction.

Good primary care training in first aid at spinal injuries.