Backbone bruise

Spinal contusion refers to one of the types of spinal cord injury and is classified as a stable trauma, accompanied by morphological changes in the spinal cord. The severity of the bruise of the spine, its consequences and prognosis directly depend on the mechanism of contusion, the cause of the injury.

A spinal injury can lead to functional (reversible) or organic (irreversible) injuries to the spinal cord - hemorrhages, circulatory disorders of the cerebrospinal fluid, circulation, necrotic foci, crushing, alteration of the morphological structure. Possible morphological lesions are characterized by the preservation of the integrity of the spine and spinal cord, but most often m are accompanied by a violation of the conductivity of the cerebrospinal fluid (cerebrospinal fluid). Injuries of the spine are considered to be among the most difficult and dangerous, although they occupy no more than 4% of the total number of traumatic injuries of the human body.

According to the International Classification of Diseases (ICD-10), the spinal contusion is defined as follows

• S14.0 - concussion and edema of the cervical spinal cord.
• S24.0 - concussion and edema of the thoracic spinal cord.
• S34.1 - another trauma of the lumbar spinal cord.

[1], [2]

Causes of bruise of the spine

The etiology of almost all mechanical injuries of the spine is a direct or indirect injury, a blow, which is indicated in the definition of damage - contusio (bruise).

• Causes of a bruise to the spine: 
• A mechanical blow from the outside is a blast wave, a blow by a heavy object.
• A common trauma, called a "diver's" injury, is a blow when jumping into the water with developing back injury (flat-beat) or cervical (impact to the bottom).
• Road traffic accidents.
• Household injuries, most often falling from a height.
• Sports injuries (active and contact sports).
• Falling on the back with syncope.
• Compression trauma of the spine with unsuccessful landing on legs.
• Violent pressure, a blow to the spine with blockages.

The etiological causes of injury of the spine are determined by the following damage parameters: 

• Strength, intensity of impact.
• The speed of the impact, the speed of movement of the car that got into an accident.
• The height with which a person falls.
• The height with which the object falls on the back.
• Age and state of health of the affected person.
• The weight of the victim's body.
• Anatomical features, the presence of chronic deforming diseases of the spine.

From the point of view of biomechanics, the upper lumbar and lower thoracic parts of the spine are considered to be the most vulnerable zones for injuries and bruises. More than 40% of the total number of PSMT (spinal cord injuries) is located in these zones. Also, the lower jaw area is often bruised.

Statistically, the causes of a spinal injury look like this: 

• More than 60% of those who get into a car accident get a bruise of the spine of one degree or another, in 30% of them a vertebral column fracture is diagnosed.
• In 55% of cases, the cervical spine suffers.
• In 15% of the chest area - T-Tx.
• In 15%, the thoracolumbar zone Tx-L is damaged.
• In 15%, the lumbar region is injured.

[3], [4], [5]

Symptoms of a bruise of the spine

Light bruises of the spine, unfortunately, occur, rarely, in such cases only soft tissues suffer and everything is limited to hematoma, severe concussions are characterized by neurologic disorders of varying severity and damage to the spinal cord. To diagnose bruises of the spinal column is not easy, because the general symptomatology is not specific, the pain is felt practically in all zones of the spine, immobility develops. In addition, a sharp disruption in the excitability of nerve endings, a reduction in all spinal cord reflexes characteristic of concussion, spinal shock eclipses all other clinical manifestations that could concretize the diagnosis. The most typical and first symptom of a spine injury is a partial or complete conductivity rupture, accompanied by a loss of sensitivity in areas under the control of the affected area.

Symptoms of a bruise of the spine are varied and depend on the severity of the stroke, contusion: 

1. A slight concussion of the spine is accompanied by symptoms of partial disturbance of conduction of the SM (spinal cord). Functionally restored within 1-1,5 months.
2. Contusions of moderate severity are characterized by a syndrome of zonal or complete, but not menacing, functional conductivity. The work of the spine is restored within 3-4 months, partial residual neurologic manifestations in the form of paresis are possible.
3. Severe contusion of the spine is characterized by complete conduction damage, a prolonged recovery period, during which partial neurological disorders of the spinal cord remain and do not respond to therapy.

The clinical picture of the spine injury by phases: 

• The beginning is characterized by symptoms of spinal shock - loss of reflexes, sensitivity, usually below the site of the injury, paralysis, violation of urination and defecation. Spinal shock often makes diagnosis difficult, because the main signs that indicate the severity of the injury appear after the resolution of the shock state.
• Manifestations of conduction disturbance - partial or complete.
• Changes in the activity of movements - loss of reflexes (areflexia), paresis (atonic paralysis).
• Gradual loss of sensitivity, spreading down from the site of the injury (conductor type).
• Vegetative syndrome - a violation of tissue trophism (dryness, decubitus), a violation of thermoregulation.
• Severe dysfunction of the pelvic organs.
• Complete morphological conduction disorder (transverse lesion).

The clinical symptoms of a spinal injury, depending on the area of damage, can be as follows: 

• Light contusion of the spine: 
  • Sharp pain in the site of injury.
  • Developing edema, it is possible hematoma in the place of injury.
  • Pain can spread down the vertebral column.
• A bruise combined with a trauma of the cervical spine: 
  • Pain in the area of the injury.
  • Disturbance of respiratory function, shortness of breath, intermittent breathing, possible to stop breathing.
  • Partial paralysis, paresis, decreased muscle reflexes, tone, sensitivity.
  • Spastic syndrome due to impaired conductivity of the spinal cord.
  • Complete paralysis.
• Contusion in the thoracic region of the spine: 
  • Hypesesia, partial loss of sensitivity of lower, upper extremities.
  • Complete loss of sensitivity of the extremities.
  • Ataxia, impaired coordination, limb movements.
  • Pain extending into the heart area, in the left shoulder, arm.
  • Disturbance of breathing, painful inhalation, exhalation.
• Contusion with a trauma of the sacro-lumbar zone: 
  • Functional leg paresis.
  • Paralysis of the legs.
  • Loss or decrease of reflexes.
  • Violation of the process of urination - incontinence or delay.
  • Impotence in men.

Most often, an easy bruise of the spine is characterized by paresthesia and a feeling of weakness in the limbs, to which the victim does not pay attention. When he seeks medical help, these clinical manifestations are already subsiding, but any contusion requires at least an X-ray examination. It should also be taken into account that a bruise of the spine of any severity is always accompanied by structural disturbances in roots, tissue, brain substance, in the vascular system. Even if the patient has no signs of spinal shock, in order to avoid subarachnoid hemorrhages, focal necrosis (myelomalacia), all necessary diagnostic measures should be carried out. The most dangerous symptom of a spinal injury is the lack of signs of partial restoration of conduction, functions during the first two days, which indicates an irreversible nature of the injury and an unfavorable prognosis.

In the clinical sense, the bruise of the spine differs according to the zones of trauma, which are most often localized in the following departments:

Injury of the lumbar spine

According to statistical data, it takes more than half of the diagnosed cases and is most often accompanied by paresis of the lower extremities, loss of sensitivity below the lumbar region and the corresponding dysfunction of the urinary system and sphincter. 

1. A severe bruise on the L2-L4 line may be manifested by a flaccid paralysis of the extensor muscles in the knee, a paresis of the muscles flexing and leading the thigh, and a decrease in the knee reflex.
2. The concussion of segment L5-S1 is accompanied by partial paresis or complete paralysis of foot movements, muscle paresis, controlling knee, thigh, atony of calf muscles - loss of heel (Achilles) reflex.
3. Contusion of level L1-L2. In men, it can be fairly accurately diagnosed with a surface cremaster dough, as a result of which the reflex of the musculus cremaster, a muscle that tightens the testicle, is lost (reduced).
4. The contusion of the lumbar spine, affecting the transverse processes of the vertebrae, is accompanied by complete paralysis of the legs (paraplegia), loss of sensitivity, atrophy of the muscles of the thighs and buttocks, rectal paralysis, atony or paralysis of the bladder. As a rule, all the main reflexes are lost, but the zones located above the site of the injury retain normal innervation.

A favorable prognosis with bruises of the lumbar spine is possible if the functions of the pelvic organs, hamstrings remain, bending movements remain in the hip regulation, the sensitivity remains in the feet, ankles. Weakness and small manifestations of paresis are compensated by medical and rehabilitation measures. Also, attention should be paid to the fact that concussions of the lumbar region are often accompanied by kidney trauma, which, when diagnosed, should be excluded or confirmed.

Cervical spine injury

Despite the fact that vertebral column injuries are usually classified as a stable form of spinal trauma, cervical contusions are most often unstable, as 90% are accompanied by a displacement of the vertebral body by more than 5-6 millimeters. The bruise of the cervical region even without signs of fracture is characterized as a severe trauma and has a high percentage of deaths. 

A bruise on the C1-C4 line is most often accompanied by spinal shock and tetraplegia - paralysis of the hands and feet, a violation of respiratory functions. Often, such victims need artificial respiration, ventilation and almost completely immobilized.

A bruise of the C3-C5 level is characterized by neurological disorders in the form of a respiratory disorder, when the victim breathes is forced by contraction of the muscles of the chest, neck, back (ancillary respiratory muscles).

A severe bruise in the zone of decussatio pyramidum - the transition of the spinal cord into an oblong one in 99% results in a fatal outcome due to the termination of the functions of the respiratory and vascular centers.

A slight bruise of the cervical spine in the zone of decussatio pyramidum is accompanied by a temporary paresis of the hands.

Neck injury, accompanied by compression of the brain in the region of the foramen occipitale magnum (occipital foramen), is manifested by the paresis of the arm and leg, pain in the nape, irraddiruyuschey in the shoulder, neck.

A bruise of the C4-C5 level can immobilize the hands and feet, but the respiratory functions are preserved.

The contusion of the C5-C6 line is accompanied by a decrease in the radial and biceps reflex.

The bruise of the C7 vertebra is manifested by the weakness of the hands, fingers, and a decrease in the triceps reflex.

The concussion of the vertebrae of the C8 level is also characterized by weakness of the wrist, fingers and a decrease in the Bechterew's reflex (metacarpal reflex)

In addition, the bruise of the cervical spine is symptomatically manifested by myosis (narrowing of the pupils), ptosis (descending of the upper eyelids), pathological dryness of the face (anhidrosis), oculosympathetic Horner syndrome.

[6], [7]

Injury of the thoracic spine

Symptomatically manifested disorders of cutaneous sensation of the whole body at points called dermatomes: in the eye, ear, supraclavicular, intercostal-brachial, radial, femoral-genital, gastrocnemius and other nerves. Symptoms of chest contusion: 

• Spinal shock.
• Change in sensitivity by conductor type, below the area of the injury.
• Disturbance of respiratory function is possible.
• The bruise of the Th3-Th5 segment is often accompanied by cardialgia.
• Partial paralysis or weakness in the legs.
• Sexual dysfunction.
• Partial impairment of pelvic organs (defecation, urination).
• A bruise of the vertebrae of the Th9-Th10 level is accompanied by a partial paresis of the muscles of the lower peritoneal zone, the displacement of the navel due to the stress of the press (Bivor's symptom).
• The Rosenbach's reflex decreases (lower abdominal reflex).
• Possible transient pain in the middle zone of the back.
• A severe bruise above the Th9 segment is accompanied by complete paralysis of the legs, which is extremely difficult to treat and rehabilitate.

A more favorable prognosis is when the bruise of the thoracic spine is localized in the Th12 segment and below it, in such cases recovery and restoration of motor activity is possible, if there are no fractures.

Bruising of the sacral spine

Almost always it is combined with a trauma of a brain cone (coccyx). As a rule, after the symptoms of spinal shock, motor activity disorders are not observed, if there are no severe fractures and complete conduction disruption. 

A bruise of the S3-S5 level is accompanied by anesthesia, a loss of sensitivity in the perianal, saddle zone, severe concussion can be accompanied by a violation of urination and defecation, temporary erectile dysfunction.

A bruise of the sacral spine at the level of S2-S4 is fraught with a decrease in the bulbocavernous and anal reflex.

If the bruise is accompanied by a trauma of the bundle of the lower roots - the cauda equina, intense pain in the lumbar region, paresis of the legs, a decrease in tendon reflexes is possible.

[8]

Injury of the lumbosacral spine

Most often accompanied by flaccid paralysis of individual zones of the lower extremities and loss of sensitivity by the conductor type, that is, below the site of the injury. Symptoms, which may manifest a bruise of the lumbosacral spine: 

• Spinal shock.
• Loss of plantar, cremasterous, Achilles reflexes.
• Strong concussion is accompanied by a decrease in knee reflexes.
• All abdominal reflexes are preserved.
• Possible dysfunction of the pelvic organs.
• Contusion of segments L4-5-S1-2 is manifested by peripheral paralysis (epiconus syndrome), flaccid paralysis of the feet, decreased achilles reflexes, loss of sensitivity of the muscles of the posterior-external zone of the thigh, impaired urination and defecation.
• S3-5 level contusion is characterized by dysfunction of pelvic organs with chronic incontinence of feces and urine, loss of sphincter tone with almost complete safety of leg movements.

Bruises of the lumbosacral zone are dangerous consequences - chronic atony of the bladder, radicular syndrome, although contusions of mild severity are considered curable and have a favorable prognosis.

Compression bruise of the spine

Compression bruise of the spine is one of the most common back injuries, which is characterized by compression (flattening) of vertebral bodies. Statistics of compression contusions look like this: 

• Compression injury of the cervical region - 1,5-1,7%.
• Compression injury of the spine of the upper chest zone - 5.6-5.8%.
• Compression of the middle chest zone of the spine is 61.8-62% (level IV-VII).
• Compression bruise of the lower thoracic region - 21%.
• Compression of the lumbar region - 9,4-9,5%.

The cause of compression injuries is an intense axial load, jumping from a high altitude and an unsuccessful landing on your feet, less often a fall from a height.

Contusion, accompanied by compression of the spinal cord, is associated with a constant irritation of corpus vertebrae (the body of the vertebra) with bone fragments, internal hematomas that resulted from trauma.

The first clinical signs of compression of the spinal cord are aching pains in the back, less often - radicular syndrome. These symptoms can appear after several weeks, months after injury (jump, fall), when the compression process is already turning into an acute stage. The most common compression injury is diagnosed in the thoracic region and is manifested by muscle weakness, a gradual decrease in the sensitivity of the hands, changes in the functions of the pelvic organs (frequent urination, delayed urination, violation of defecation), sexual dysfunctions. The clinical signs of compression injuries are rapidly progressing, so if you have the first signs and have a history of injury, you should immediately contact a traumatologist or a vertebrologist.

[9], [10], [11], [12]

Severe bruise of the spine

A severe bruise of the spine in clinical practice occurs much more often than a concussion of the spinal cord with light concussion, since a severe bruise, as a rule, is a consequence of subluxation or vertebral fracture (or vertebrae). Such concussions are diagnosed as irreversible, as they lead to organic, structural damage to the substance of the spinal cord, to hemorrhage and the formation of necrotic foci. A severe bruise of the spine always manifests itself as a pronounced spinal shock in the clinical sense and often leads to such complications: 

• Thromboembolism at the site of injury or in other areas.
• Ascending myelencephalon edema - the medulla oblongata with a bruise of the cervical spine.
• Thrombosis is a vein thrombosis.
• Traumatic bronchopneumonia.
• Infections, sepsis of the urinary tract.
• Contracture of joints.
• Decubitus - decubitus.

A severe bruise of the spine may have an unfavorable prognosis for the crane with complete destruction of the outer shell of the spinal cord, if functions, reflexes are not restored within two days after the injury, at least in part.

Treatment of a bruise of the spine

Therapeutic measures, treatment of the spine injury directly depend on the timely call to the doctor and complex diagnosis, which includes X-ray examinations (CT, MRI), myelography and other methods. In any case, even with an unspecified diagnosis with the injured from a bruise, the spine is treated as with potentially serious patients with a serious spinal trauma.

The main methods of treatment of spinal contusion are in the provision of first aid, acute transport, long-term complex therapy and rehabilitation measures. If the bruise is diagnosed as mild and 24 hours later, the patient's functions, reflexes are restored, home treatment is possible with strict bed rest, immobilization of the affected area, massage, thermal treatment procedures. In more serious situations, hospitalization is necessary, where both conservative and surgical treatment is possible. Severe bruises, accompanied by a life-threatening symptomatology, require intensive therapeutic actions - restoration of blood pressure, breathing, heart work.

In the hospital, the closed direction of the deformations obtained is applied, it is possible to stretch, immobilize with corsets, collars. The surgical method of neutralizing vertebral deformations helps to eliminate compression trauma and restores the blood circulation of the injured zone. Also reconstructive surgery is indicated in cases when conservative treatment for a long period does not give results. It should be noted that the treatment of the spinal contusion now involves the use of new, modern techniques when traumatologists try not to resort to surgical intervention and use effective hardware techniques.

First aid with a bruise of the spine

The first action that must be applied to the victim is to ensure complete immobilization. If a person lies, it can not be moved or lifted in any way, as the damage to the spinal cord (compression) is possibly worse. The victim carefully turned over on the stomach and gently moved face down on the stretcher. If it is possible to transport on a hard surface, a shield, then the patient can be placed on his back.

First aid for a bruise of the spine in the cervical region is to immobilize the collar zone with special tires or a dense tissue (not squashing). In addition, it is possible to impose a cold on the site of injury, if breathing functions are disturbed, assist in the form of artificial respiration. Other independent actions are unacceptable, since spinal injuries, even bruises, require the actions of specialists. The most important thing in case of a spinal injury is to deliver the victim as soon as possible to a medical institution where all the necessary and adequate injuries will be taken.

[13], [14]

What to do with a spinal injury?

The first steps are to try to ensure complete immobilization of the victim and apply a cold compress to the area of the injury to stop swelling and spread the hematoma. Further to the question - what to do with a bruise of the spine will be answered by a traumatologist, surgeon or doctor who will take the patient in a medical facility. As a rule, the algorithm of the doctors' actions is as follows: 

• Transportation of the victim to a hospital.
• Urgent diagnostic measures, assessment of the patient's condition.
• Symptomatic therapy, perhaps, intensive therapy.
• If the condition is assessed as stable, in addition to immobilization of the injured zone, the appointment of symptomatic therapy and observation is not required.
• If the condition is unstable, repositioning and subsequent immobilization or stabilizing surgical intervention is necessary.

What to do with a bruise of the spine, if the injury occurred in the home and there is no one nearby who would have given first aid? It is necessary urgently to call emergency medical aid, and before its arrival to try not to move. Even if the injury is assessed by the injured as light, it is necessary to undergo an X-ray examination, exclude possible complications and get professional advice on restoring the functions of the spinal column.

How to prevent a spinal injury?

Prevention of a spinal injury is mainly preventive measures against recurrence of trauma and possible complications. Unfortunately, it is not possible to prevent spinal injuries, as they are etiologically conditioned by 70% of household, emergency factors, 20% by sport and only a small percentage refers to negligence or accidental situations. Prevention of a spinal injury is a reasonable load on the spinal column, training of the muscular corset, normalization of body weight, maximum caution on the road and observance of safety rules in everyday life, treatment of diseases of the spine - osteochondrosis, osteoporosis and others. It should be remembered that the spine carries a heavy load throughout our entire life and gives us the opportunity not only to move, but also to feel ourselves a full-fledged person. If you take care of your own foundation, and the spine is called Columna vertebralis, which is the pillar of the pillar, it will never lead and will serve for a long time.

Timing of recovery with a bruise of the spine

The timing of recovery and prognosis for bruises depend on the severity of contusions, on the characteristics of the human body, the presence of concomitant diseases, the area of injury and other factors. A bruise of the spine, whose recovery period is difficult to predict, is a form of spinal trauma, and in any case is accompanied by a disruption of the cerebrospinal fluid, subarachnoid hemorrhage. The recovery period is associated with the period of edema reduction and the ability to regenerate damaged nerve endings, restore soft tissue trophism. Contusions of moderate severity are treated for a long time and the rehabilitation period can take at least a year, although the movement is partially restored 2 months after the start of treatment. Heavy bruises have the property of preserving partial symptomatology during life, since the violation of the nerve endings does not recover, some spinal functions are often lost. It should be noted that a bruise can not be considered an easy trauma, as it is often accompanied by fractures and subluxations, which is statistically predicted as 40-50% of the disability of a particular group. In this sense, the bruise of the spine is no less serious injury than damage to the brain, and the recovery period is similar to the recovery time for brain injuries. The main condition for a possible early recovery can be considered timely provided competent help and the desire of the victim to comply with all medical recommendations, including long rehabilitation courses.