Spinal contusion: symptoms, diagnosis, treatment
The content of the article:
- Causes of spinal bruises
- Classification of spinal contusions
-
Spine contusion symptoms
- No spinal cord injury
- With spinal cord injury
- First aid
- Diagnostics
-
Spinal contusion treatment
- Non-drug therapy
- Evaluation of the effectiveness of treatment
- Effects
- Video
A spinal injury is a soft tissue injury in the area of the spinal column. It can occur from a fall on the back or a blow, during a traffic accident, playing sports, industrial or natural disasters.
In case of injury, soft tissues in the spine are injured
Spinal injuries account for 3 to 5% of all closed injuries and 5–17% of all injuries of the musculoskeletal system. In more than half of cases, spinal cord injury (SCI) is combined with damage to other organs and tissues. Bruises can occur in people of any age and gender, more often in children, men of working age and the elderly.
A bruise is manifested by pain, swelling and restriction of movement. In mild cases, only the soft tissues of the back are damaged, in severe cases, contusion of the spinal cord can be observed in combination with neurological symptoms.
Causes of spinal bruises
Most often, SCI occurs when you fall on your back while slipping on a smooth surface or while engaging in traumatic sports.
Spinal bruises are caused by falling on the back
Damage to the cervical spine is often noted as a result of the so-called whiplash injury - a sudden movement of the head forward or backward during an accident during emergency braking of the car. Trauma to the thoracic and lumbar spine in road traffic accidents are less common.
Cervical injuries are often associated with whiplash
Also, PSI often occurs during recreation on the water. When the head hits the surface of the water or the bottom, the cervical region is usually damaged, when falling flat on the water - the thoracic and lumbar regions.
Classification of spinal contusions
In terms of severity, a spinal contusion can be:
| Severity | Description |
| Easy | Only soft tissues are damaged, including skin, muscles, subcutaneous fatty tissue. Neurological symptoms do not develop |
| Average | The injury is accompanied by a concussion of the spinal cord. Transient neurological disorders are noted, which usually disappear from a few hours to 2-3 weeks |
| Heavy | Spinal cord injury occurs. There are functional pathological changes in combination with pathomorphological disorders in the form of hemorrhage into the tissue of the spinal cord, the formation of foci of necrosis. Pronounced neurological symptoms are characteristic. The average recovery time is in the range of 3-5 weeks. Possible consequences: paresis, areflexia, impaired sensitivity, etc. |
According to the terms, the PSMT is divided into periods:
- acute: first 3 days;
- early: interval from 3 days to 3-4 weeks;
- intermediate: interval from 1 to 3 months;
- late: more than 3 months.
By the type of damage, in addition to bruises, SCI can take the form of a fracture, dislocation, self-healing dislocation, fracture-dislocation of the vertebrae, spondyloptosis, partial / complete rupture of the capsular-ligamentous apparatus of the vertebral motor segment, rupture of the intervertebral disc.
Other types of classification:
- the nature of the spinal cord injury: SCI can be complicated or uncomplicated (with or without damage to the spinal cord and spinal nerves);
- localization: contusion can affect the cervical, thoracic, lumbar and sacral regions, multiple multilevel injuries of the spinal column or multiple or multilevel injuries of the spine are possible;
- the degree of violation of the integrity of the integument: PSMT can be closed, open and penetrating.
If a traumatic injury is combined with a fracture of the spinal column, this type of SCI is considered a serious injury. According to the mechanism of formation, fractures are divided into compression, distraction and rotational.
Spine contusion symptoms
Trauma manifests itself with the following symptoms:
- local pain syndrome;
- antalgic reflex muscle contraction;
- limitation / impossibility of movements in the spine;
- change in the axis of the spine, sometimes there is a kyphotic deformity in the area of damage;
- bruising, swelling, wounds and abrasions of soft tissues.
The site of injury usually hurts locally
Neurological disorders are possible in the form of impaired sensitivity, motor function, function of the pelvic organs below the level of damage, etc.
No spinal cord injury
A bruise is manifested by back pain, which is aggravated by active movements, standing and walking. At the moment of injury, there is no breath holding.
The pressure on the spinous processes is painless or accompanied by minor pain due to damage to the superficial soft tissues.
With spinal cord injury
This type of injury is characterized by sharp pain at the time of injury. The severity of neurological disorders is determined by the localization of the damaged area.
If the vertebrae of the cervical spine are bruised, symptoms such as ptosis, pathological dryness of the face and constriction of the pupils may appear. In the case of involvement of the brain stem in the process, there may be cardiac and respiratory disorders, including difficulty breathing or forced breathing, which involves the muscles of the neck, chest and back.
Injury can manifest as paralysis of the upper, lower, or all four limbs. Reflexes are reduced or absent. With severe spinal injuries, respiratory arrest and death are possible.
With a bruise of the lumbar spine, there may be flaccid paralysis of certain areas of the lower extremities or impaired sensitivity, dysfunction of the pelvic organs.
First aid
A spinal injury in the prehospital stage is difficult to differentiate from more severe injuries, including unstable fractures. In this regard, when providing first aid, one should proceed from the fact that any movement can cause a deterioration in the condition and lead to an aggravation of neurological symptoms.
Immobilization is necessary when providing first aid
All patients with suspected spinal injury (including unconscious patients after being beaten, accident, falling from a height, diving in shallow water) should be immobilized at the detection site. The most effective is the combination of a rigid head holder with a rigid shield under the back, fastening the victim with belts.
Diagnostics
To make a diagnosis, it is necessary to find out the mechanism of injury, the symptoms that arose immediately at the time of injury. During the examination, complaints of pain in the area of spinal injury, sensory and motor disorders, and dysfunction of the pelvic organs are assessed.
To clarify the diagnosis, computed or magnetic resonance imaging is prescribed
The main diagnostic measures include:
- spine radiography in frontal and lateral projection;
- computed or magnetic resonance imaging;
- general and biochemical blood test;
- general urine analysis;
- ECG;
- coagulogram;
- Ultrasound and radiography of the abdominal organs.
Consultation of a therapist, surgeon, traumatologist is required; according to indications, an examination by a doctor of another profile may be required.
Spinal contusion treatment
The goal of therapy is:
- fixation and stabilization of the spinal motion segments for early rehabilitation;
- decompression of the spinal cord and its roots.
Pain relief and antibiotic prophylaxis are usually given. Also, depending on the indications, is carried out:
- correction of microcirculation disorders: Pentoxifylline;
- stimulation of synaptic transmission of nerve impulses: Galantamine;
- relief of spastic syndrome with central paralysis and paresis: Baclofen.
Non-drug therapy
In the first three days, bed rest is recommended. If there are no gross neurological disorders, after this period you can walk with a walker. You can get up only in a removable rigid corset. Depending on the severity of the injury, it must be worn for up to 6 months.
In the presence of a gross neurological deficit, the victim should lie on an anti-decubitus mattress. Starting from the first day of bed rest, every 2 hours it should be actively turned in bed (from back to stomach and sideways), you can give the body a semi-vertical position.
Physiotherapy is indicated to accelerate recovery.
It is necessary to start carrying out physiotherapy exercises at an early date - from the second day after an uncomplicated injury. You should also pay attention to breathing exercises, which is the prevention of hypostatic pneumonia.
Physiotherapy is indicated starting from the 2nd to 4th day. It can include massage, magnetotherapy, electrophoresis, ultrasound, laser therapy, UHF therapy, etc.
Evaluation of the effectiveness of treatment
The effectiveness of the treatment is assessed based on the following criteria:
- reliable stabilization of spinal motion segments, elimination of compression factors for the structures of the spinal canal;
- absence of complications, including bedsores, pneumonia, uroinfections, gastrointestinal bleeding, etc.
Effects
The outcome of an injury varies widely: from complete recovery to disability.
The functional consequences of a spinal injury depend on many factors: the nature and degree of injury, the adequacy and timeliness of the first aid provided, treatment and rehabilitation measures.
Video
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Anna Kozlova Medical journalist About the author
Education: Rostov State Medical University, specialty "General Medicine".
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