Spine Injuries: Symptoms

A reliable indication of damage to the spinal cord is a clear definition of the level of injury, above which there are no neurological changes, and below neurological functions are either completely absent or significantly reduced. The features of clinical manifestations depend on the level and degree of damage to the spinal cord (complete or partial).

Spine injuries, as well as other fractures or dislocations, are very painful, but patients suffering from pain caused by other concomitant injuries (for example, fractures of long bones), as well as with impaired consciousness due to intoxication or TBI, complaints of back pain may not present.

Symptoms of spinal cord injury depending on localization

Localization of damage	Possible Symptoms
Higher C	Paralysis of the breath and in many cases death
At or above C4	Full tetraplegia
C1	Paralysis of the lower limbs, with the possibility of flexion and retraction of the hands
C6	Paralysis of the lower extremities, wrists and brushes, but movements in the shoulder joint and flexion of the ulnar are usually possible
Above T2	For transverse damage, dilated pupils
Between Th12 and Th11	Paralysis of the muscles of the lower limbs above and below the knee joint
From T2 to T12	Paralysis below the knee
Ponytail	Paresis of the lower limb with hyporeflexia or areflexia and usually with pain and hyperesthesia along the course of the propagation of nerve roots
OT S3 to S or the cerebral cone in L1	Violation of the function of the pelvic organs

Symptoms of complete spinal cord injury

The rupture leads to immediate, complete flaccid paralysis (including loss of sphincter tone of the anus), autonomic dysfunction below the level of damage, loss of sensitive and reflex activity.

High damage to the cervical region (above C1) causes respiratory failure with impaired pulmonary ventilation due to impaired respiratory muscle function, especially when injured above C3. Autonomous dysfunction with cervical injury can lead to bradycardia and arterial hypotension, spinal shock, in which, unlike other forms of shock, the skin remains warm and dry. Arrhythmias and instability of blood pressure are possible. The cause of death of patients with high damage to the cervical region is often pneumonia, especially associated with mechanical ventilation.

Flaccid paralysis after a few hours or days is gradually becoming spastic because of the increase in normal stretch reflexes that appear against the background of the weakening of the mechanisms that counteract them. Later, if the lumbosacral bundle is not damaged, spasm of flexor muscles appears, deep tendon and autonomic reflexes are restored.

Symptoms of partial spinal cord injury

There is a partial loss of motor or sensory innervation, which, depending on the etiology, can be permanent or short-lived. Short-term impairment of function is due to concussion, more prolonged - injury or damage. Sometimes, after a concussion of the spinal cord, rapidly developing edema leads to a complete disruption of the function and mimics its hollow rupture. Clinical manifestations of spinal shock (not to be confused with neurogenic shock) go through a few days, often residual disturbances remain.

The clinical picture depends on the location of the lesion in the spinal cord. There are several specific syndromes.

Syndrome Brown-Sekar arises from the damage of half the diameter of the spinal cord. The patient on the side of the lesion is observed spastic paralysis, the loss of positional sensitivity is below the damage, on the opposite side - the loss of pain and temperature sensitivity.

Anterior cerebrospinal syndrome is the result of direct damage to this zone or anterior cerebrospinal artery. The patient loses movement and pain sensitivity on both sides below damage.

Central spinal cord syndrome usually occurs in patients with a narrowing of the spinal canal (congenital or degenerative) after over-extension. Motor disorders in the hands are more pronounced than in the legs.

If the posterior parts of the spinal cord are damaged, the patient loses positional, vibration and tactile sensitivity. If the spinot-lamic path is interested, painful, temperature and often superficial and deep muscular sensitivity are lost.

Hemorrhage (haematomyelia) usually occurs in the gray matter of the cervical spinal cord, leading to signs of damage to the lower motoneurons (muscle weakness, twitching of the muscle fibers, decreasing tendon reflexes of the hands) that persists for a long time. Motor weakness, often proximal, is combined with selective disturbance of pain and temperature sensitivity.

Symptoms of horse tail damage

Loss of movement and / or sensitivity, as a rule, is partial. The tone of the sphincter of the anus is reduced. Functions of the intestine and bladder are broken, incontinence or delay possible. In men, there is a violation of erectile function, and in women - a decrease in libido.

Complications of spine trauma

The consequences depend on the severity and level of damage. In case of damage at level C or higher, respiratory disturbances may occur. Reduced mobility increases the risk of thickening of the blood and pressure sores. Spasticity can develop. Autonomic dysreflexia can occur in response to irritating factors such as pain and pressure on any part of the body. Chronic neurological pain is manifested by a burning sensation or tingling sensation.

[1], [2], [3], [4], [5], [6]