Spinal contusion

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

A spinal contusion can lead to functional (reversible) or organic (irreversible) damage to the spinal cord – hemorrhages, disorders of cerebrospinal fluid circulation, blood circulation, necrotic foci, crushing, changes in the morphological structure. Possible morphological damage is characterized by the preservation of the integrity of the spinal column and spinal cord, but most often they are accompanied by a violation of the conductivity of the CSF (cerebrospinal fluid). Spinal injuries are considered to be among the most complex and dangerous, although they account for no more than 4% of the total number of traumatic injuries to the human body.

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

• S14.0 – contusion and swelling of the cervical spinal cord.
• S24.0 – contusion and swelling of the thoracic spinal cord.
• S34.1 - Other injury of lumbar spinal cord.

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Causes of spinal contusion

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

• Causes of spinal contusion:
• Mechanical impact from outside – blast wave, impact with a heavy object.
• A common injury called a "diver's contusion" is a blow from jumping into water that results in damage to the back (flat impact) or neck (impact on the bottom).
• Road traffic accidents.
• Household injuries, most often falls from height.
• Sports injuries (active and contact sports).
• Falling on your back when fainting.
• Compression injury of the spine due to an unsuccessful landing on the feet.
• Forceful pressure, blow to the spine during collapses.

The etiological causes of spinal contusion are determined by the following parameters of damage:

• The strength and intensity of the blow.
• The speed of the impact, the speed of the vehicle involved in the accident.
• The height from which a person falls.
• The height from which an object falls on the back.
• The age and health status of the injured person.
• The body weight of the victim.
• Anatomical features, 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 the most vulnerable areas for injuries and bruises. More than 40% of all SSCI (spinal cord injuries) are localized in these areas. The lower cervical area is also often subject to bruises.

Statistically, the causes of spinal contusion look like this:

• More than 60% of all those involved in a car accident suffer a spinal contusion of varying severity, and 30% of them are diagnosed with a spinal fracture.
• In 55% of cases, the cervical spine is affected.
• In 15% of cases, the chest area is affected – T-Tx.
• In 15% of cases, the thoracolumbar region is damaged – Tx-L.
• In 15% of cases, the lumbar region is injured.

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Symptoms of a Spinal Contusion

Mild spinal contusions, unfortunately, are rare, in such cases only soft tissues suffer and everything is limited to a hematoma, severe contusions are characterized by neurological disorders of varying severity and damage to the spinal cord. It is not easy to diagnose spinal contusions, since the general symptoms are not specific, pain is felt in almost all areas of the spine, immobility develops. In addition, a sharp violation of the excitability of nerve endings, a decrease in all spinal reflexes - spinal shock, characteristic of contusion, overshadows all other clinical manifestations that could specify the diagnosis. The most typical and first symptom of a spinal contusion is a partial or complete rupture of conductivity, accompanied by a loss of sensitivity in the zones controlled by the damaged area.

Symptoms of a spinal contusion vary and depend on the severity of the blow, contusion:

1. Mild contusion of the spine is accompanied by symptoms of partial conduction disorder of the spinal cord. Functionally restored within 1-1.5 months.
2. Moderate contusion is characterized by a syndrome of zonal or complete, but not threatening, functional conductivity. The spine recovers within 3-4 months, partial residual neurological manifestations in the form of paresis are possible.
3. A severe spinal contusion is characterized by complete conduction damage, a long recovery period, during which partial neurological disorders of the spinal cord remain and do not respond to therapy.

Clinical picture of spinal contusion by phases:

• The onset is characterized by symptoms of spinal shock - loss of reflexes, sensitivity, usually below the site of injury, paralysis, impaired urination and defecation. Spinal shock often complicates diagnosis, since the main signs that indicate the severity of the injury appear after the shock condition has resolved.
• Manifestations of conduction disturbances – partial or complete.
• Changes in motor activity – loss of reflexes (areflexia), paresis (atonic paralysis).
• Gradual loss of sensitivity, spreading downwards from the site of injury (conduction type).
• Vegetative syndrome – tissue trophism disorder (dryness, bedsores), thermoregulation disorder.
• Severe dysfunction of the pelvic organs.
• Complete morphological conduction disorder (transverse lesion).

Clinical symptoms of spinal contusion, depending on the area of damage, may be as follows:

• Mild contusion of the spinal column:
  • Sharp pain at the site of injury.
  • Developing edema, possible hematoma at the site of the injury.
  • The pain may radiate down the spine.
• Contusion combined with injury to the cervical spine:
  • Pain in the area of the injury.
  • Impaired respiratory function, shortness of breath, intermittent breathing, possible respiratory arrest.
  • Partial paralysis, paresis, decreased muscle reflexes, tone, sensitivity.
  • Spastic syndrome due to impaired conduction of the spinal cord.
  • Complete paralysis.
• Contusion in the thoracic spine area:
  • Hypoesthesia, partial loss of sensitivity in the lower and upper extremities.
  • Complete loss of sensitivity in the limbs.
  • Ataxia, impaired coordination and control of limb movements.
  • Pain spreading to the heart area, left shoulder, arm.
  • Difficulty breathing, painful inhalation and exhalation.
• Contusion with trauma to the lumbosacral region:
  • Functional paresis of the legs.
  • Paralysis of the legs.
  • Loss or reduction of reflexes.
  • Disruption of the urination process - incontinence or retention.
  • Impotence in men.

Most often, a mild spinal contusion is characterized by paresthesia and a feeling of weakness in the limbs, which the victim does not pay attention to. When he seeks medical help, these clinical manifestations have already subsided, but any contusion requires at least an X-ray examination. It should also be taken into account that a spinal contusion of any severity is always accompanied by structural disorders in the roots, tissue, brain matter, and vascular system. Even if the victim does not have 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 contusion is the absence of signs of partial restoration of conductivity, functions during the first two days, which indicates the irreversible nature of the injury and an unfavorable prognosis.

In a clinical sense, spinal contusion is differentiated by the zones of injury, which are most often localized in the following areas:

Lumbar spine contusion

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

1. A severe contusion on the L2-L4 line can manifest itself as flaccid paralysis of the extensor muscles in the knee, paresis of the muscles that flex and adduct the hip, and a decrease in the knee reflex.
2. Contusion of the L5-S1 segment is accompanied by partial paresis or complete paralysis of foot movements, paresis of the muscles that control the movement of the knee and hips, atony of the calf muscles - loss of the heel (Achilles) reflex.
3. Contusion of the L1-L2 level in men can be diagnosed quite accurately using a superficial cremaster test, which shows how the reflex of the musculus cremaster, the muscle that pulls up the testicle, is lost (reduced).
4. A 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 basic reflexes are lost, but the areas located above the site of the contusion retain normal innervation.

A favorable prognosis for lumbar spine contusions is possible if the functions of the pelvic organs and thigh muscles are preserved, flexion movements in the hip joint remain normal, and sensitivity in the feet and ankle joints is preserved. Weakness and minor manifestations of paresis are compensated by therapeutic and rehabilitation measures. It should also be noted that lumbar contusions are often accompanied by kidney injuries, which should be excluded or confirmed during diagnosis.

Cervical spine contusion

Although spinal contusions are generally classified as a stable form of spinal injury, cervical contusions are most often unstable, as in 90% of cases they are accompanied by a displacement of the vertebral body by more than 5-6 millimeters. A cervical contusion, even without signs of a fracture, is characterized as a severe injury and has a high percentage of fatal outcomes.

A contusion on the C1-C4 line is most often accompanied by spinal shock and tetraplegia - paralysis of the arms and legs, and respiratory failure. Often such victims require artificial respiration, ventilation of the lungs, and are almost completely immobilized.

Contusion at level C3-C5 is characterized by neurological disorders in the form of respiratory distress, when the victim breathes forcibly by contracting the muscles of the chest, neck, and back (auxiliary respiratory muscles).

A severe contusion in the decussatio pyramidum zone – the transition of the spinal cord into the medulla oblongata – in 99% of cases ends in death due to the cessation of the functions of the respiratory and vascular centers.

A slight contusion of the cervical spine in the decussatio pyramidum zone is accompanied by temporary paresis of the arms.

A contusion of the neck, accompanied by compression of the brain in the area of the foramen occipitale magnum (foramen magnum), is manifested by paresis of the arm and leg, pain in the back of the head, radiating to the shoulder and neck.

A C4-C5 contusion can immobilize the arms and legs, but respiratory functions are preserved.

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

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

Contusion of the C8 vertebra is also characterized by weakness of the wrist, fingers and a decrease in the Bechterew reflex (carpometacarpal reflex)

In addition, a cervical spine contusion is symptomatically manifested by miosis (narrowing of the pupils), ptosis (drooping of the upper eyelids), pathological dryness of the face (anhidrosis), and Horner's oculosympathetic syndrome.

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Contusion of the thoracic spine

Symptomatically manifested by disturbances of skin sensitivity of the whole body in points called dermatomes: in the zone of the ocular, ear, supraclavicular, intercostal-brachial, radial, femoral-genital, sural and other nerves. Symptoms of a contusion of the thoracic region:

• Spinal shock.
• Change in sensitivity of the conductive type, below the area of injury.
• Respiratory function may be impaired.
• Contusion of the Th3-Th5 segment is often accompanied by cardialgia.
• Partial paralysis or weakness in the legs.
• Sexual dysfunctions.
• Partial dysfunction of the pelvic organs (defecation, urination).
• Contusion of the vertebrae at the Th9-Th10 level is accompanied by partial paresis of the muscles of the lower peritoneum, displacement of the navel due to abdominal tension (Beevor's symptom).
• The Rosenbach reflex (lower abdominal reflex) is reduced.
• Transient pain in the middle back area is possible.
• A severe contusion above the Th9 segment is accompanied by complete paralysis of the legs, which is extremely difficult to treat and rehabilitate.

The prognosis is more favorable when the contusion 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.

Sacral spine contusion

Almost always combined with trauma to the medullary cone (coccyx). As a rule, after the symptoms of spinal shock, there are no motor activity disorders, unless there are severe fractures and complete conduction impairment.

Contusion of level S3-S5 is accompanied by anesthesia, loss of sensitivity in the perianal, saddle-shaped zone, severe contusion can be accompanied by impaired urination and defecation, temporary erectile dysfunction.

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

If the bruise is accompanied by an injury to the bundle of lower roots - the equine tail, intense pain in the lumbar region, leg paresis, and decreased tendon reflexes are possible.

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Contusion of the lumbosacral spine

Most often, it is accompanied by flaccid paralysis of individual zones of the lower extremities and loss of sensitivity along the conductive type, that is, below the site of the injury. Symptoms that may indicate a lumbosacral spine injury:

• Spinal shock.
• Loss of plantar, cremasteric, and Achilles reflexes.
• A severe contusion is accompanied by a decrease in knee reflexes.
• All abdominal reflexes are preserved.
• Dysfunction of the pelvic organs is possible.
• Contusion of the L4-5-S1-2 segments is manifested by peripheral paralysis (epiconeus syndrome), flaccid paralysis of the feet, decreased Achilles reflexes, loss of sensitivity of the muscles of the posterior outer thighs, and impaired urination and defecation.
• Contusion of level S3-5 is characterized by dysfunction of the pelvic organs with chronic incontinence of feces and urine, loss of sphincter tone with almost complete preservation of leg movements.

Contusions of the lumbosacral region are dangerous due to their consequences - chronic atony of the bladder, radicular syndrome, although mild contusions are considered curable and have a favorable prognosis.

Compression injury of the spine

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

• Compression contusion of the cervical spine – 1.5-1.7%.
• Compression contusion of the spine in the upper thoracic region – 5.6-5.8%.
• Compression of the mid-thoracic spine – 61.8-62% (level IV-VII).
• Compression contusion of the lower thoracic region – 21%.
• Compression of the lumbar region – 9.4-9.5%.

The cause of compression bruises is intense axial load, jumping from a great height and unsuccessful landing on the feet, and less often, falling from a height.

A contusion accompanied by compression of the spinal cord is associated with constant irritation of the corpus vertebrae (vertebral body) by bone fragments and internal hematomas that arise as a result of the injury.

The first clinical signs of spinal cord compression are aching back pain, less often – radicular syndrome. These symptoms may appear several weeks or months after the injury (jump, fall), when the compression process has already entered the acute stage. Most often, compression injury is diagnosed in the thoracic region and manifests itself as muscle weakness, gradual decrease in sensitivity of the arms, changes in the functions of the pelvic organs (frequent urination, urinary retention, bowel movement disorder), sexual dysfunction. Clinical signs of compression injuries progress rapidly, so when the first signs appear and there is an injury in the anamnesis, you should immediately contact a traumatologist or vertebrologist.

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Severe spinal contusion

A severe spinal contusion is much more common in clinical practice than a spinal contusion with a mild contusion, since a severe contusion is usually a consequence of a subluxation or fracture of a vertebra (or vertebrae). Such contusions are diagnosed as irreversible, since they lead to organic, structural damage to the spinal cord substance, to hemorrhage and the formation of necrotic foci. A severe spinal contusion always manifests itself as a clinically pronounced spinal shock and often leads to the following complications:

• Thromboembolism at the site of injury or in other areas.
• Ascending swelling of the myelencephalon - medulla oblongata in case of contusion of the cervical spine.
• Thrombosis - vein thrombosis.
• Traumatic bronchopneumonia.
• Infections, sepsis of the urinary tract.
• Joint contractures.
• Decubitus - bedsores.

A severe spinal contusion can have a very unfavorable prognosis in the case of complete destruction of the outer shell of the spinal root, if within two days after the injury, at least partially, functions and reflexes are not restored.

Treatment of spinal contusion

Therapeutic measures, treatment of spinal contusion directly depend on timely visit to the doctor and comprehensive diagnostics, which include X-ray examinations (CT, MRI), myelography and other methods. In any case, even with an unrefined diagnosis, victims of spinal contusion are treated as patients with potential serious spinal injury.

The main methods of treating spinal contusion include first aid, careful transportation, long-term complex therapy and rehabilitation measures. If the contusion is diagnosed as mild and the patient's functions and reflexes are restored within 24 hours, treatment at home is possible with strict bed rest, immobilization of the injured area, massage, and thermal treatment procedures. In more serious situations, hospitalization is necessary, where both conservative and surgical treatment are possible. Severe contusions, accompanied by life-threatening symptoms, require intensive therapeutic measures - restoration of blood pressure, breathing, and heart function.

In hospital, closed reduction of the resulting deformations is used, possibly traction, immobilization with corsets, collars. The surgical method of neutralizing spinal deformations helps to eliminate compression trauma and restores blood circulation in the injured area. Reconstructive surgery is also indicated in cases where conservative treatment over a long period does not give results. It should be noted that the treatment of spinal contusion currently involves the use of new, modern methods, when traumatologists try not to resort to surgical intervention and use effective hardware techniques.

First aid for spinal contusion

The first action that must be taken with the victim is to ensure complete immobilization. If the person is lying down, he should not be moved or lifted under any circumstances, as this may worsen the damage to the spinal cord (compression). The victim is carefully turned over onto his stomach and carefully moved face down onto a 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 spinal contusion in the cervical region consists of immobilizing the collar zone with special splints or dense fabric (without squeezing). In addition, you can apply cold to the site of the contusion, and in case of respiratory failure, provide assistance in the form of artificial respiration. Other independent actions are unacceptable, since spinal injuries, even contusions, require the actions of specialists. The most important thing in case of a spinal contusion is to deliver the victim to a medical facility as quickly as possible, where all necessary measures adequate to the injury will be taken.

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What to do if you have a spinal injury?

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

• Transporting the victim to the hospital.
• Urgent diagnostic measures, assessment of the patient's condition.
• Symptomatic therapy, possibly intensive therapy.
• If the condition is assessed as stable, nothing is required other than immobilization of the injured area, symptomatic therapy and observation.
• If the condition is unstable, reduction and subsequent immobilization or stabilizing surgery are necessary.

What to do if you have a spinal contusion if the injury occurred at home and there is no one nearby to provide first aid? You must immediately call emergency medical care, and try not to move until it arrives. Even if the contusion is assessed by the victim as minor, you must undergo an X-ray examination, rule out possible complications and receive professional recommendations for restoring the functions of the spinal column.

How to prevent spinal cord injury?

Prevention of spinal contusion is mainly preventive measures against relapses of injury and possible complications. Unfortunately, it is not possible to prevent spinal contusions, since etiologically they are caused by 70% of household, emergency factors, 20% by sports, and only a small percentage is due to carelessness or accidental situations. Prevention of spinal contusion is a reasonable load on the spinal column, training of the muscular corset, normalization of body weight, maximum caution on the road and compliance with safety rules at home, treatment of spinal diseases - osteochondrosis, osteoporosis and others. It should be remembered that the spine bears a large load throughout our lives and gives the opportunity not only to move, but also to feel like a full-fledged person. If you take care of your foundation, and the spine is not accidentally called Columna vertebralis - a supporting column, then it will never lead and will serve for a long time.

Recovery times for spinal contusion

The recovery period and prognosis for bruises depend on the severity of the contusion, the characteristics of the human body, the presence of concomitant diseases, the injury zone and other factors. A spinal contusion, the recovery period for which is difficult to predict, is a form of spinal injury, and in any case is accompanied by a violation of the cerebrospinal fluid, subarachnoid hemorrhage. The recovery period is associated with the time it takes to reduce swelling and the ability to regenerate damaged nerve endings, restore trophism of soft tissues. Moderate bruises are treated for a long time and the rehabilitation period can take at least a year, although movement is partially restored 2 months after the start of treatment. Severe bruises tend to retain partial symptoms throughout life, since the damage to the sheath of nerve endings cannot be restored, some spinal functions are often lost. It should be noted that a bruise cannot be considered a minor injury, since it is often accompanied by fractures and subluxations, which is statistically predicted as 40-50% of disability of a particular group. In this sense, a spinal contusion is no less serious an injury than a brain injury, and the recovery period is similar to the rehabilitation period for brain injuries. The main condition for a possible speedy recovery can be considered timely competent assistance and the desire of the victim to follow all medical recommendations, including long-term rehabilitation courses.