spine fracture - Causes, Symptoms and Treatment .MF .

August 12, 2017 17:52 | Emergencies

Vertebral fractures are the most severe injuries of the musculoskeletal system.There are fractures of the spine as a result of injuries a large mechanical energy: traffic accidents, injuries at work, drop, inappropriate human behavior in the swimming areas (jump "pike" in an unfamiliar place), etc.In elderly persons and elderly fracture can occur even from minor trauma, due to the fragility of the bones due to a small content of calcium in the bone.

The spine consists of individual vertebrae (bones of the spine components) and passing through them, the spinal cord.For fractures of the vertebrae are damaged individual - one or several at once.Fractures may occur in all parts of the spine: cervical, thoracic, lumbar and sacral, the most dangerous fractures of the cervical spine, becauseoften accompanied by spinal cord injury.

There are many types of fractures of the spine, which is due to the versatility of traumatic exposure and the complex structure of the spine and vertebrae.Vertebral fractures may b

e accompanied by dislocation and subluxation of the vertebrae, with dislocation and subluxation of the vertebral bodies are moved relative to each other, which leads to jamming and damage to the spinal cord.The spinal cord may also be damaged by fragments of broken vertebrae, squeezed posttraumatic hematoma (accumulation of blood due to injury).

Accordingly, all fractures of the spine can be divided into two large groups:
Uncomplicated - without damage to the spinal cord.
Complicated fractures - accompanied by spinal cord injury.

most common type of spine fractures - a compression fracture of the vertebral body.Compression fracture occurs due to a sharp compression of the vertebrae.Most often in elderly persons and generally rarely accompanied by a shift and spinal cord injury.

Symptoms of spinal fracture

The main symptoms of vertebral fractures include:

pain in the affected area of ​​the spine
Pain usually is persistent character, enhanced by the move.There increased pain during palpation of the damaged vertebra, as well as creating an axial load on the spine (the doctor in this case on top of Tapping the patient's head or an additional load nanadplechya patient).

limited movement in the spine
limited movement due to severe pain, as well as violation of the anatomical structures of the spine and surrounding muscles.

visible deformity of the affected spine
department observed with significant damage to one or more vertebrae.

• In complicated fractures to the above symptoms added symptoms of spinal cord injury .
the spinal cord is the most severe complication of fractures, which can lead to death or disability of the patient.Symptoms in this case are multifaceted and can manifest itself in different degrees - from mild sensory disturbances of the skin and slight muscle weakness below the fracture of the spine, to the complete disappearance of the independent movement (paralysis), and loss of control over urination and defecation.

First aid in cases of suspected fracture of the spine

Before a doctor or a person rendering first aid, the challenge is to rule out other, less serious spinal injury (injury, damage to the ligament apparatus).Due to the fact that the picture of the disease are similar, even with the slightest suspicion of a fracture, first aid should be carried out, as in fractures of the spine, to the final diagnosis.
First Aid is immobilization (immobilization) of the spine and adequate anesthesia.

Immobilization and transport
man with suspected fracture of the spine is placed and transported lying on the back, using a hard board or a special stretcher, the maximum locking the torso and leg.To shift a person without the need for a place to place is not worth it.If a hard board under the hands are not available, you can instead use the means at hand: wide board, plywood, etc.Independently moving patient smoking, is also undesirable to transport a person sitting.
When fractures of the cervical neck need to create an additional fixation of the collar.The collar can also make improvised - a piece of cardboard or solid matter. Under no circumstances should one try to straighten visible damage to the cervical vertebrae.

Anesthesia
Selection tools for anesthesia based on the principle - the more, the better.The most common drugs in everyday life - it nimesulide ketorol and analgin.
Do not give the tablets, if a person is on the verge of losing consciousness, or is unconscious, it can lead to penetration of the drug into the airways.

diagnosis of vertebral fracture

doctor already at the initial examination may be suspected fracture of the spine, and finally put the diagnosis is possible only by means of X-ray studies.In some cases: for spinal cord injuries, suspected spinal cord injury, in difficult to diagnose cases, computed tomography (CT) or magnetic resonance imaging (MRI) can be used.
Sometimes there is a need for carrying out a puncture of the spinal canal, and myelography - both studies aimed at assessing the circulation of the cerebrospinal fluid, but at this time are rare.

In setting nature of spinal cord injury doctor traumatologist often requires medical attention - a neurologist, and they are determined, together with a further therapeutic tactics.

treatment and rehabilitation of patients with spine fracture

Perhaps the most difficult problem is the treatment of vertebral fractures.Medical tactic is different, but in general there are two main areas: the conservative and operative methods.Rarely applicable in modern times - the traction method and closed reduction of fractures.

Conservative treatment of spine fracture
This method does not involve surgery.Apply in fractures without displacement and fractures without spinal cord injury.

conservative way is to long-term bed rest, for fractures of the thoracic and lumbar spine, or wearing a collar fixation for fractures of the cervical spine.The total period of bed rest varies, depending on the damage of 1 to 3 months.Subsequently, the patient must wear a half a year before the fixation corset and avoid intense exercise.In case of damage of the cervical fixation lasts from 2 to 3 months.

fixation collar

simultaneously with fixing or bed rest is necessary to actively carry out physiotherapy, aimed at forming a muscular corset and protection, so that the displacement of the vertebrae and the excess load.Exercises should be performed with a gradually increasing load, for example from the first days after injury only allowed to perform breathing exercises, further allowed to move his arms and so on.All exercises should be performed only with the permission and under the control vracha.Takzhe in later periods after the injury (more than 3 months) is allowed to float, and the gradual return of the person to work.

to reduce inflammation in the damaged zone is assigned to physiotherapy.

Medicines , used in uncomplicated fractures of the spine can be divided into several groups:

1) Calcium - intended to accelerate the fusion of the vertebral (Calcemin, Calcium D3-Nycomed, various vitamin complexes).
2) Drugs that prevent the destruction of intervertebral cartilage (Teraflex, Don 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 treatment of fractures of the spine
operative method of treatment is used for fractures, accompanied by spinal cord injury;in fractures with significant vertebral subluxation: the fracture-dislocation of the vertebrae;in cases where there is no guarantee that the fragments or broken vertebra not damage the spinal cord, with a further conservative treatment.Indications for surgery is always strictly individual and each applies its treatment strategy, taking into account all the possible consequences of surgery.

Regarding art surgery, the operation aimed at liberation and protection of the spinal cord from further damage.By means of special metal structures achieved stabilization and strengthening of the damaged segment.In the future, the treatment is no different from the conservative method: long limitation exercise, bed rest, massage, medical gymnastics and physiotherapy.For medicinal therapy, besides the above, it may be applied a specific treatment prescribed by a neurologist or neurosurgeon to maintain the spinal cord.

Metal structures of the spine gets in the remote period after the injury, but the properties of modern surgical alloys allow to leave last a lifetime.Indications for reoperation to remove the clamps are solved individually, depending on the age, complaints and consequences.

method of stretching the spine
Apply for the gradual elimination of displacement of the vertebrae, if you can not technically perform the operation or at high risk for surgery.The patient in this case is laid down on the bed and locked loops, straps, cotton-gauze rings for the head or the armpits, thus creating a craving, reduce a fracture.Next comes the conservative treatment.

Method closed reposition
This method requires a skilled surgeon's hands, and now almost does not apply, due to the danger of displacement of bone fragments in the future, even with a secure fit.

When fractures are not accompanied by paralysis and other manifestations of spinal cord injuries, return to work within a period of 3 months (fractures of the cervical spine) to six months (fractures of the lumbar and thoracic).

forecast for fractures of the spine

In the initial stages of treatment the prognosis is very cautious, even in uncomplicated fractures.Some patients do not even have time to get to the emergency department of the hospital, dying of severe complications - spinal shock (a condition caused by damage to or rupture of the spinal cord).

Patients diagnosed with a spinal cord injury in the future may suffer from paralysis and unable to move on their own for several months or years, or even a lifetime.In uncomplicated fractures in the future there may be diseases such as herniated discs, spinal osteochondrosis.Therefore, great importance is the long-term rehabilitation, both in hospital and at home.

doctor traumatologist NAVaranovich