Fracture of the cervical vertebrae, its symptoms and treatment
Fracture of the cervical spine is one of the most dangerous injuries. It can lead to disability or death. The prevalence of such corruption, unfortunately, is increasing.
The classification of fractures of the neck
The number of such injuries is increasing in accordance with increase in the number of high-speed transport, work at height and lack of security. Most often this injury occurs during a crash or sudden stop when the head inertia during braking going forward, and when you stop sharply back (the so-called whiplash injury). Special attention is drawn to the fact that 90 % of the victims are young people aged 16 to 40 years. Due to the high risk of adverse outcome should be on the lookout for trauma and know how to provide first aid before arrival of doctors.
The mechanism of occurrence there are currently 3 types of fractures of the neck:
- type A – due to compression (compression) of the vertebra force that acted along the axis;
- In type b, due to compression with subsequent stretching;
- type C – as a result of compression, stretching and rotation.
The most severe is the fracture type, in which the entire vertebra collapses.
The cervical spine consists of 7 vertebrae. Depending on the structure of vertebral fractures are divided into 3 groups:
Each group of fractures corresponds to the location and structure of the respective vertebrae.
As there are fractures of the cervical
Fracture of the body of Atlanta (S1) in accordance with its structure has a special mechanism of occurrence. For the first cervical vertebra is the typical appearance of the tissue defect when the compression axis, leading to its destruction. Atlanta, having annular shape, burst like a bagel 4 or more parts that go on the sides (the Jefferson fracture).
The second cervical vertebra (axis) has a structure similar to the other vertebrae, except for one feature – the presence of the odontoid process. With it, he articulates with C1. The damage to the body of the axis (C2) is often accompanied by fracture of the odontoid process of the form, which can be displaced both in length and width. When it occurs when excessive flexion it is shifted forward, and when extension – ago. The fracture of a tooth of the second cervical vertebra with displacement is a dangerous criterion for the predictive point of view. The consequences of the displacement of the first cervical vertebra with the odontoid process of the posterior is spinal cord compression and death.
Also one of the typical injury with axial load and hyperextension of the leg is a fracture of the vertebral arch (traumatic spondylolisthesis). It is characterized by extreme mobility. A fracture of this localization could be asymptomatic with minimal displacement, but the displacements on the width of the vertebra there are consequences in the form of spinal cord compression of the rear arc Atlanta (C1).
When damage to the vertebral bodies from C2 to C7 isolated comminuted and compression fractures.
The latter are accompanied by damage to the anterior surface of the vertebrae, but they do not bear the risk of damaging the spinal cord. Fragmentation, in which the vertebral body collapses into several pieces, followed by the offset, can have very serious consequences. The displacement in the direction of the spinal canal they increase neurological symptoms and can lead to significant violations of up to death.
A fracture of the transverse processes of the vertebrae in the cervical spine characterized by their direct injury when the impact is applied from the back directly in the area of processes. Due to the fact that the appendages attached muscles, and back spines break off for such injury is characterized by the displacement of the transverse processes down. Fracture of the spinous processes occurs when a blow to the back of the spine and excessive hyperextension or sudden flexion.
Manifestations and diagnosis of injuries
Fractures of the vertebral bodies does not have a specific clinical picture. They manifest pain at first diffuse type, and in an hour it is limited to the site of injury. The pain may radiate to the neck or shoulder blade. With a slight irritation of the spinal cord the possible occurrence of feelings of tingling or numbness. With significant damage the supporting structures of the typical symptoms in the form of a forced position of the head:
- the head is slightly deflected toward the lesion;
- head strongly inclined, but held by the neck muscles;
- the head is held by hands (a symptom of hanging man).
Radiological diagnosis of fracture of the first and second cervical vertebrae specific – x-ray through the mouth. Shown MRI (magnetic resonance imaging) and CT (computed tomography), if you define a spine fracture or neurologic symptoms are identified. MRI allows better visualization of soft tissue injuries of the spine: intervertebral discs, ligaments, nerve structures. CT will better show the location of the bone defect, the extent of her injuries and will provide an opportunity to clarify the level and severity of spinal cord injury.
The symptoms of fracture of the transverse processes occur immediately after the injury. The first to draw attention to the pain of high intensity that is amplified in the supine position. In this position the patient can lift the straightened leg straight. With the active slope of the patient there is pain on the affected side, and during passive movements of the balance. When you touch (palpation) to two parallel lines that are on the edges of the spine, increased pain at the level of the injured vertebra. On radiographs the fracture is best visualized in the anteroposterior projection. Line the tissue defect may take place in three ways: oblique, transverse and longitudinal.
To fracture the spinous process of the characteristic local pain in the affected bone. It is worse when bending or unbending.
Noted increased pain on palpation. During its carrying out it is possible to detect discrepancies in the location of one of the spinous processes, the displacement of a broken bone in the side and abnormal mobility. Best bone defect is visible on radiographs in lateral projection.
At the site of trauma with suspected fracture of one of the cervical vertebrae of the person is restricted movement in the cervical spine. The victim is placed on his back on a hard surface and transportyou to the hospital. The paramedics fixed him neck collar Philadelphia.
The cervical fractures without displacement are treated with fixation with a stiff collar or a cervico-thoracic corset which the patient is forced to wear at least 2-3 months. Next, it is necessary within 2-3 weeks of wearing a collar Schantz. Recommended to use physical therapy (physiotherapy) and massage the muscles.
Fractures that are accompanied by displacement of bone fragments, first mapped. It can be done using closed reduction or by surgery. In connection with a high probability to injure the spinal cord, which leads to serious consequences up to death, prefer operation.
During surgery produce the elimination of the compression of the vertebrae, remove damaged bone parts and replace the defect with grafts of different materials. Next is a similar immobilization (limitation) of the cervical spine, and fractures without displacement. It is recommended to focus on physical therapy for the reason that with minor compression of the spinal cord develops weakness of the hands and feet.
Physical therapy conducted in the early stages of treatment, will lead to muscle tone and get rid of complications. Enough to regularly strengthen the movement for arms and legs without loading the spine.