What Are the Different Types of Spinal Injury?

Spine and spinal cord injuries often occur in industrial and mining and traffic accidents, and can occur in batches during wartime and natural disasters. The injuries are severe and complicated, with multiple injuries, multiple injuries, many complications, poor prognosis when combined with spinal cord injury, and even cause lifelong disability or life-threatening.

Causes of spinal and spinal cord injuries

The etiology of this disease can be classified as follows:

1. It can be divided according to the direction of violent effect at the time of injury

Flexion type, straight type, flexion rotation type and vertical compression type.

2. Based on stability after fracture

Can be divided into stable and unstable.

3.Armstrong-Denis classification

It is a general classification at home and abroad. It is divided into compression fracture, burst fracture, posterior column fracture, fracture dislocation, rotation injury, compression fracture combined with post fracture, burst fracture combined with post fracture.

4. Classified by site

Can be divided into cervical spine, thoracic spine, lumbar spine fracture or dislocation. According to the anatomical part of the vertebra, it can be divided into vertebral body, vertebral arch, lamina, transverse process, spinous process fracture and so on.

5. Traumatic spinal cord injury without fracture and dislocation

It occurs in children and middle-aged and elderly patients, and is characterized by no fracture and dislocation on imaging examination.

Clinical manifestations of spinal and spinal cord injuries

Spinal fracture

Has a history of severe trauma, such as falling from a high altitude, hitting the head or neck or shoulders with heavy objects, landslides, traffic accidents, etc. The patient felt local pain in the injury, impaired movement of the neck, cramps in the lower back muscles, and could not stand up. Local fractures can be associated with localized posterior deformities. Because retroperitoneal hematoma stimulates autonomic nerves and slows bowel movements, symptoms such as abdominal distension and abdominal pain often occur. Sometimes it needs to be distinguished from abdominal organ damage.

2. Combined spinal cord and nerve root injuries

After spinal cord injury, motor, sensory, reflex, and sphincter and autonomic nerve functions below the injury level are impaired.

(1) Sensory disorders Pain, temperature, touch, and proprioception below the level of the injury weaken or disappear.

(2) Dyskinesia During spinal shock, paralysis occurs below the spinal cord injury segment, and the reflex disappears. If the spinal cord is traumatized after the shock period, upper motor neuron paralysis occurs, muscle tone increases, and tendon reflexes become hypertonic, with palatal and ankle clonus and pathological reflexes.

(3) Sphincter dysfunction Spinal cord shock is characterized by urinary retention, which is caused by the formation of a tension-free bladder due to bladder detrusor paralysis. After the shock period, if the spinal cord is injured above the level of the diaphragm, an auto-reflective bladder can be formed. The residual urine is less than 100ml, but urination cannot be free. If the level of spinal cord injury is in the sacral spinal cord or sacral nerve root injury, urinary incontinence occurs. The emptying of the bladder requires emptying the urine by increasing abdominal pressure (squeezing the abdomen by hand) or using a urinary catheter. Constipation and incontinence also occur in the stool.

(4) Incomplete spinal cord injury When the distal spinal cord is injured or partially preserved, it is called incomplete spinal cord injury. There are the following types in clinical practice: Anterior spinal cord injury manifests itself as voluntary movement below the injury level and loss of pain. Since the spinal column was not damaged, the patient's sense of touch, position, vibration, movement, and deep pressure were intact. Central spinal cord injury is more common in cervical spinal cord injury. It shows the loss of upper limb movement, but the lower limb movement function exists or the upper limb movement loss is obviously more serious than the lower limb. The tendon reflexes at the injury plane disappear and the tendon reflexes below the injury plane are hyperactive. Symptoms of spinal cord hemilateral injury Syndrome of contralateral pain and temperature below the level of injury disappeared, and motor function, position, motion, and two-point perception on the ipsilateral side were lost. Posterior spinal cord injury The deep sensation, deep pressure sensation, and position sensation below the injury level are shown, while the pain and temperature sensation and motor function are completely normal. More common in wounded laminae.

Spine and spinal cord injury examination

1. X-ray inspection

Routine photography of the spine is in the lateral position, and if necessary oblique. Measure the height of the front and back of the vertebral body compared with the upper and lower adjacent vertebrae while reading the film; measure the pedicle spacing and the width of the vertebral body; measure the spinous process spacing and the width of the intervertebral disc space and compare with the upper and lower adjacent vertebral spaces. Measure the height of the pedicle in the lateral position. X-rays can basically determine the location and type of fracture.

2.CT inspection

It is helpful to determine the extent of invasion of the spinal canal by the displaced fracture block and find the bone or intervertebral disc protruding into the spinal canal.

3.MRI (magnetic resonance) examination

It is extremely valuable for judging the status of spinal cord injury. MRI can show edema and bleeding at the early stage of spinal cord injury, and can show various pathological changes of spinal cord injury, spinal cord compression, spinal cord transection, incomplete spinal cord injury, spinal cord atrophy or cystic change.

4.SEP (Sensory Evoked Potential)

It is a test method for measuring the conduction function of the somatosensory system (mainly the posterior spinal cord). It is helpful to determine the degree of spinal cord injury. MEP (Motion Induced Potential) is now available.

5. Jugular vein compression test and myelography

The jugular vein compression test has certain reference significance for judging spinal cord injury and compression. Myelography is meaningful for the diagnosis of old traumatic spinal stenosis.

Spinal and spinal cord injury diagnosis

Diagnosis can be made based on the cause, clinical manifestations, and laboratory tests.

Spinal and spinal cord injury treatment

(1) First aid and removal

Spinal cord injury

Sometimes combined with severe craniocerebral injury, chest or abdominal organ injury, vascular injury to the extremities, the life of the injured should be rescued first.

2. Anyone suspected of having a spine fracture

The patient's spine should maintain a normal physiological curve. Don't make the spine overextend and flexion. The spine should be lifted and placed on the wooden board by hand while no spin external force. Rolling method can be used when there are few people.

For patients with cervical spine injuries, someone must support the mandible and occipital bone, and slightly pull the traction along the longitudinal axis to maintain the neck in a neutral position. After placing the patient on a wooden board, put sand bags or folded clothes on both sides of the head and neck to prevent Turn your head and keep your airways open.

(B) the treatment of simple spinal fractures

1. Mild vertebral compression of thoracolumbar fracture

Be stable. The patient can lie flat on a hard board with a lumbar cushion. Back extensors can be exercised in a few days. Functional compression can restore the compression vertebral body to its original state. After 3 to 4 weeks, you can get out of bed under the protection of the chest and back support.

2. Thoracic waist compression is more than one third

It should be closed and reset. Can be overextended with two tables. Use two tables with a height difference of about 30cm. Put a soft pillow on each table. The injured person is prone, his head is placed on the high table, his hands are on the side of the table, and his thighs are on the low table. The part is suspended, and the weight is gradually reset by the overhang. After resetting, the plaster vest is fixed in this position. The fixed time is 3 months.

3. Thoracolumbar unstable spinal fractures

Vertebral compression more than 1/3, deformity angle greater than 20 °, or accompanied by dislocation can be considered open reduction and internal fixation.

4. Cervical spine fracture or dislocation

Those with light compression displacement shall be reset by traction with jaw occipital belt, and the traction weight is 3 ~ 5kg. After reduction, it was fixed with head and chest plaster for 3 months. Severe compression and displacement can sustain skull traction reduction. Traction weight can be increased to 6-10kg. X-ray film was used for reexamination, and the head and chest plaster or head and chest brace was used for fixation for 3 months.

(C) spinal fracture with spinal cord injury

The functional recovery of spinal cord injury mainly depends on the degree of spinal cord injury, but the early release of compression on the spinal cord is the primary issue to ensure the recovery of spinal cord function. Surgical treatment is an important part of comprehensive rehabilitation treatment for patients with spinal cord injury. The purpose of the operation is to restore the normal axis of the spine, restore the inner diameter of the spinal canal, directly or indirectly relieve the compression of the spinal nerve root by the fracture block or dislocation, and stabilize the spine (by internal fixation and bone graft fusion). The surgical methods are:

Anterior cervical decompression and bone graft fusion

For cervical fractures below the neck 3, traction reduction is feasible, anterior decompression or subtotal vertebral resection, bone graft fusion, internal fixation with steel plate screws or external fixation of the neck circumference. Obvious instability can continue skull traction or head and chest plaster.

2. Posterior cervical spine surgery

After dislocation, the posterior metal clip internal fixation and bone graft fusion can be performed after traction reduction. The posterior decompression plate and screw internal fixation bone fusion can be performed if necessary.

3. Anterior approach for thoracolumbar fractures

For thoracolumbar vertebral burst or comminuted fractures, multiple anterior decompression, bone graft fusion, and plate screw internal fixation were performed. Anterior decompression is feasible for old fractures.

4. Posterior approach for thoracolumbar fractures

Posterior surgery includes laminectomy, decompression, reduction and internal fixation with a pedicle screw fixation plate or steel rod. If necessary, bone graft fusion can also be performed with Harlington rod or Lukai rod wire.

(IV) Syndrome Act

Dehydration therapy

The application of 250% 20% mannitol is to reduce spinal edema.

2. Hormone therapy

Intravenous infusion of 10 to 20 mg of dexamethasone has certain significance in relieving the traumatic response of the spinal cord.

3. Some free radical scavengers

Such as vitamin E, A, C and coenzyme Q, etc., the application of calcium channel blockers, lidocaine, etc. are considered to have certain benefits in preventing secondary damage after spinal cord injury.

4. Drugs that promote nerve function recovery

Such as disodium triphosphate, vitamin B ₁ , B ₆ , B ₁₂ and so on.

5. Supportive Therapy

Pay attention to maintaining the water and electrolyte balance of the wounded, supplementing calories, nutrition and vitamins.