Fracture of the spine - Causes, symptoms and treatment. MF.

Fractures of the spine are the most severe injuries of the musculoskeletal system. There are fractures of the spine due to traumas of great mechanical energy: traffic accidents, injuries at work, falling from a height, with improper behavior of a person in places of bathing( jump "pike" in an unfamiliar place), etc. In elderly and elderly people, a fracture can occur even from minor trauma, due to the fragility of bones, which is due to the low content of calcium in the bone.

The spine consists of separate vertebrae( the bones forming the spine) and the spinal cord passing through them. In fractures, individual vertebrae are damaged, one or more at once. Fractures can occur in all parts of the spine: cervical, thoracic, lumbar and sacral, the most dangerous fractures of the cervical region, tk.most often accompanied by damage to the spinal cord.

There are many types of vertebral fractures that are associated with the multifaceted nature of traumatic effects and the complex structure of the spine and vertebrae. Fractures of the spine may be accompanied by dislocations and subluxations of the vertebrae, with the dislocation and subluxation of the body of the vertebrae moving relative to each other, which leads to pinching and damage to the spinal cord. The spinal cord can also be damaged by fragments of broken vertebrae, squeezed by post-traumatic hematoma( accumulation of blood due to trauma).

In accordance with this, all fractures of the spine can be divided into 2 large groups:
Uncomplicated - without damage to the spinal cord.
Complicated fractures - accompanied by damage to the spinal cord.

The most common type of vertebral fracture is the compression fracture of the vertebral body. Compression fracture occurs due to sharp compression of the vertebrae. Most often it happens in the elderly and is usually rarely accompanied by a displacement and damage to the spinal cord.

Symptoms of a spine fracture

The main symptoms of a spinal fracture include:

• Pain in the affected area of ​​the spine
Pain, as a rule, is of a persistent nature, increases with movement. There is an increase in pain during palpation of the damaged vertebra, as well as when creating an axial load on the spine( the doctor in this case pokolachivaet patient on the crown of the head or creates an additional burden on the patient's shoulder).

• Restriction of movements in the spine
Restriction of movements is caused by severe pain, as well as a violation of the anatomical structure of the spine and adjacent muscles.

• Visible deformation of the affected spine
Observed with significant damage to one or more vertebrae.

• For complicated fractures, the symptoms of spinal cord injury are added to the above symptoms.
Spinal cord injury is the most formidable complication of fractures, which can lead to the death or disability of the patient. Symptoms in this case are multifaceted and can be manifested in varying degrees - from slight disruption of the sensitivity of the skin and a slight muscle weakness below the vertebral fracture, to the complete disappearance of independent movements( paralysis) and loss of control over urination and defecation.

First aid for suspected fracture of the spine

Before the doctor or first aid person, the task is to exclude other, less serious, spine injuries( bruise, ligament damage).Due to the fact that the disease patterns are similar, even with the slightest suspicion of a fracture, first aid should be given, as with spinal fractures, until the final diagnosis is made.
The first aid is immobilization( immobilization) of the spine and adequate anesthesia.

• Immobilization and transportation of
A person with suspected fracture of the spine is laid and transported lying on his back using a hard shield or special stretcher, maximally fixing the trunk and legs. It is not necessary to shift a person unnecessarily from place to place. If a hard shield is not available at hand, then you can use the available tools instead: a wide board, plywood, etc. Independently to move the patient it is forbidden, also it is undesirable to transport the person sitting.
In cases of fractures in the cervical region, it is necessary to create an additional fixation of the neck with a collar. The collar can also be made from improvised tools - a piece of cardboard or dense material. In no case should you try to correct visible damage to the cervical vertebrae.

• Analgesia
The choice of anesthetic is based on the principle - the stronger, the more effective. The most common medications in everyday life are nimesulide, ketorol and analgin.
Do not give pills if the person is on the verge of unconsciousness or unconsciousness, this can lead to medication getting into the respiratory tract.

Diagnosis of a spinal fracture

A doctor already at a primary examination can suspect a fracture of the spine, and finally can only be diagnosed by radiographic examination. In some cases: in cases of spinal cord injuries, suspected spinal cord injuries, computed tomography( CT) or magnetic resonance imaging( MRI) can be used in cases that are difficult to diagnose.
Sometimes there is a need for puncture of the spinal canal and myelography - both studies are aimed at evaluating the circulation of cerebrospinal fluid, but are rarely performed at this time.

In setting the character of spinal cord injury, a traumatologist often needs the help of a neurologist and they are determined together with further therapeutic tactics.

Treatment and rehabilitation of a patient with a spinal fracture

Perhaps the most difficult task is the treatment of vertebral fractures. The therapeutic tactics are different, but in general, there are two main directions: conservative and operational methods. Rarely applicable in modern times - the method of traction and closed reinforcement of fractures.

• Conservative method for treatment of
vertebral fracture This method does not involve surgical intervention. Applicable for fractures without displacement and fractures without damage to the spinal cord.

Conservative method consists in prolonged bed rest, with fractures of the thoracic and lumbar spine, or with the use of a fixative collar for fractures of the cervical spine. The total period of bed rest varies, depending on the damage, from 1 to 3 months. In the future, the patient needs to wear a fixation corset for up to six months and avoid intense physical exertion. With damage to the cervical region, fixation lasts from 2 to 3 months.

Fixation collar

Simultaneously with fixation or bed rest, it is necessary to actively perform therapeutic gymnastics aimed at forming a muscular corset and thus protecting the vertebrae from displacement and overload. Exercise should be performed with a gradually increasing load, for example, from the first days after the injury only breathing exercises are allowed, then it is allowed to move your hands and so on. All exercises must be performed only with the permission and under the supervision of the doctor. Also in the later periods after the injury( more than 3 months), swimming and the gradual return of a person to work are permitted.

For the removal of inflammation in the area of ​​damage, physiotherapeutic treatment is prescribed.

Drugs , used for uncomplicated vertebral fractures, can be divided into several groups:

1) Calcium preparations - directed to accelerate the fusion of the vertebra( Calceminum, Calcium D3-Nycomed, various vitamin complexes).
2) Preparations that prevent the destruction of the intervertebral cartilage( Teraflex, Dona, Alflutop).
3) Anti-inflammatory and analgesic drugs( Nimesulide, Meloxicam, Ketorolac, Diclofenac).
4) Various gels and ointments for topical use( Ultrafastin, Voltaren, Ketoprofen, Fastum gel, etc.).

• Operative method for the treatment of spinal fractures
An operative method of treatment is used for fractures accompanied by damage to the spinal cord;at fractures with a significant subluxation of the vertebrae: with fractures and dislocations of the vertebrae;in those cases where there is no guarantee that the fragments or broken vertebra will not damage the spinal cord, with further conservative treatment. Indications for the operation are always strictly individual and to each applicable its own treatment tactics, considering all possible consequences of surgical intervention.

Regarding the technique of surgical intervention, all operations are aimed at relieving and protecting the spinal cord from further damage. With the help of special metal structures, stabilization and strengthening of the damaged segment is achieved. In the future, the treatment is no different from the conservative method: prolonged restriction of physical activity, bed rest, massage, medical gymnastics and physiotherapy. For drug therapy, in addition to the above, specific treatment may be applied, appointed by a neurologist or neurosurgeon to maintain the function of the spinal cord.

Metal structures are extracted from the spine in the remote period after injury, but the properties of modern surgical alloys allow you to leave the last for life. Indications for a repeated operation for the removal of fixatives are decided individually, depending on the age, complaints and consequences.

• Spinal traction method
Used for gradual elimination of vertebral displacement, when it is impossible to perform the operation technically or at a high risk of surgical intervention. The patient in this case is laid on the bed and fixed with loops, straps, cotton-gauze rings over the head or axillary hollows, thus creating a draft that directs the fracture. Next is conservative treatment.

• Closed-in method
This method requires skilled hands of the surgeon and is currently not practical, due to the risk of displacement of fragments in the future, even with reliable fixation.

In fractures that are not accompanied by paralysis and other manifestations of spinal cord injury, labor is returned to work within 3 months( fractures of the cervical spine) to six months( fractures of the lumbar and thoracic sections).

Forecast for spine fractures

At the initial stages of treatment, the prognosis is very cautious, even with uncomplicated fractures. Some patients do not even have time to get to the hospital admission department, having died from a formidable complication - spinal shock( a condition caused by damage, or a rupture of the spinal cord).

Patients who are diagnosed with spinal cord injury may later suffer paralysis and do not move for months or years, or even their whole lives. In uncomplicated fractures in the future, such diseases as intervertebral hernia, osteochondrosis of the spine may occur. Therefore, long-term rehabilitation, both in a medical institution and at home, is of great importance.

The doctor traumatologist-orthopedist NA.Voronovich