Trauma of the cervical spine, prevention and treatment
Trauma of the cervical spine is injury to the vertebral column. Whiplash can be worn closed (without violating the integrity of the skin) and open (mostly due to injuries).
The causes of whiplash
Closed injuries of the cervical arise as a result of falling on the head (for example, hitting bottom when diving), stroke, birth trauma, strong and direct blow to the neck (Autorama or whiplash), birth injury, from compression, from the sharp rotational, flexor or extensor movements. It should be noted that most often automobile whiplash injury is accompanied by severe closed injury of the cervical. A whiplash injury based on severity, can lead to serious consequences long period of rehabilitation, and possible disability.
Open injuries of the cervical spine usually occur from gunshot wounds and often lead to instant death.
Birth injuries of the cervical spine of the newborn are of a mechanical nature and due to such reasons as:
- large fruit;
- premature, difficult, prolonged labor;
- narrow pelvis;
- instrumental delivery;
- gluteal (hip) fetal presentation.
Birth trauma of the cervical spine most often caused by intense stretching or direct pressure from the fingers of the obstetrician on the cervical and brachial nerve bundle when removing a child.
Natal trauma of the cervical can occur mainly in breech position of the fetus during labor.
Types of injuries
There are the following types of spinal cord injuries in the neck:
- injury to the intervertebral discs;
- dislocation (the displacement of part of the vertebra, body of vertebra, multiple vertebrae);
- sprains (tears and ruptures of ligaments);
- contusions (closed tissue damage of a mechanical nature).
Adults are often injured fifth-sixth vertebrae. Among injuries of the cervical vertebrae distinguish comminuted and compression.
Birth injuries of the cervical often lead to so-called obstetric paresis (paralysis) and damage to the spinal cord the fifth and sixth cervical segments. Sometimes when Natal injury damaged the first thoracic and seventh to eighth cervical segments.
Signs of damage to the vertebral column
The most severe form of injuries of the cervical are perelomova (a combination of luxation fractures) and dislocations. These types of injuries are accompanied by:
- damage to the brain substance;
- blood circulation;
- damage to the roots and compression of the brain;
- injuries to the intervertebral discs;
- ascending edema of the brain (compound fractures).
In closed injuries are sprains and/or fractures, bruising of tissues; possible asphyxiation and cardiac arrest.
Injuries of the cervical occur in severe damage and violate the basic functions of life. In the case of injuries usually appear changes in vessels, changes the permeability that leads to edema and hemorrhage into the surrounding tissue. The severity of injury may be different, so it is difficult to distinguish from fracture.
In dislocation of the cervical spine diagnosed by changing the shape of the spine, limitation of passive and active movements, while trying to make passive movements there is a sharp pain and a spring resistance, and when polerowanie individual vertebrae are typically dislocated bone of a vertebral body in an unusual place.
Tensile cervical vertebrae clinical picture is that you can observe swelling, soreness at the site of injury, the vertebrae have limited mobility.
Open injuries of the cervical often accompanied by damage of large vessels, thyroid gland, pharynx, esophagus, cranial nerves, spinal cord.
The main clinical symptom of damage to the cervical spine is pain, which appears since the injury and it also increases in case of movement.
If the fracture of the body of the cervical vertebra is compressive in nature, palpation reveals a painful protruding spinous process, paravertebral hypertonicity of the muscles at the site of trauma; the victim often disturbed breathing. If there is a fracture of the vertebral bone, the pain occurs when the probing process above, and in the case of injury of the cervical pain are more common. In the case of relatively light types of injuries (sprain, dislocation, contusion), abnormal shape change of the cervical can not be observed. Therefore, the diagnosis is based on radiographic studies at least in two projections.
In the case of Natal injuries of the newborn can be recorded injury to major blood vessels, spine, hemorrhage in the spinal cord, nerve roots, rupture of nerve fibers and the brain, ischemia and swelling of the spinal cord. In this case you experience the following symptoms:
- trauma of the spine;
- urinary retention;
- obstruction and respiratory failure;
- General lethargy;
- muscle hypotonia;
The diagnosis is confirmed in further research of puncture of the cerebrospinal fluid, neurological examination and electromyography.
Due to Natal injuries of the peripheral nervous system occurs the obstetric palsy, ischemia of the spinal cord (damage to the fifth and sixth cervical vertebrae). Common symptoms of the following: hand feebly hanging along the body in the position of bringing the child shoulder lowered down movement of the fingers free.
When the lower type of obstetric paralysis when damaged the seventh and eighth cervical and first thoracic vertebrae, observed paralysis of the fingers and muscles of the forearms. Complete paralysis of the brachial plexus is rare.
First aid in case of injury
In case of any injury of the cervical spine of the patient should be transported to the nearest hospital. The examination and transportation of the patient only needed lying on a blue shield. During immobilization (immobilization) of the neck on the cervical impose a special bus, or, preferably, conduct splinting through the top of the head from shoulder to shoulder. Any manipulation of the affected produce cautiously and carefully, so as not to cause more injury and damage. At the slightest suspicion of damage to the neck and spine are performing emergency hospitalization, while respecting all the requirements of transportation in such cases.
Luxation, contusion or sprain of the cervical spine first aid consists in giving rest by immobilization and early treatment to the doctor.
Aid for open wound of the cervical includes cleansing the wound, the imposition of aseptic dressings, emergency tetanus prophylaxis. If the patient is in shock, then he intramuscularly injected with the appropriate drugs.
Comprehensive treatment of the spine
When closed injuries of the cervical spine (fracture of the closed type, dislocation, sprain, contusion) treatment is usually conservative in nature: carried out the immobilization of the cervical vertebrae by the application of the plaster bandage (collar), or by traction on a special bed. In the case of injury after immobilization on the affected area impose a cold compress, lotions to reduce swelling and hemorrhage, prescribe painkillers. After two or three days, apply massage and heat physiotherapy (alcohol compresses, ultrasound, high frequency). When a large accumulation of blood in the cavities and tissues it is removed during the puncture. Successful treatment and complete recovery of the normal functioning depend on the severity and extent of physiological impairment.
In a case of dislocation of the cervical conservative treatment: traction, wearing a plaster collar, physiotherapy, physical therapy, massage.
Treatment for sprain of the cervical spine can be surgical or conservative, based on the severity of the damage. Above all, however, illustrates the immobilization of the injured area (plaster collar).
If there is a displaced fracture of the cervical spine, in hospital medical institutions are treated with traction, which is at the head (the so-called loop Gleason) on the shield or raised from the head of the bed. You must place the cushion in the region of the injured vertebrae. For injuries of the cervical, accompanied by damage to the medulla often performed surgery: remove the bone fragments, blood clots, put in place of the damaged vertebra, then spend his restraint.
Treatment of injuries of the cervical vertebrae of varying severity can last up to 1 year. They use orthopedic or unloading locking devices (collars, holders head). After five to eight weeks after uncomplicated victims of whiplash are allowed to climb and walk. An important role to restore normal physiological functioning of the cervical spine have such therapies as massage, physiotherapy and therapeutic exercise. These therapies restore function of the spine and reduce the consequences of injury.
In the treatment of birth trauma of the cervical spine is generally carried out immobilization of the neck (without bending the head). For this purpose, the orthopedic pad. Use hemostatic and antigemofilichesky funds, treatment with oxygen. If there is compression of the spinal cord in neonate blood clot performed surgery. In the future, using treatment with medications, massage, physiotherapy etc. the Success of therapy depends on the severity of the injury, the severity of the hemorrhage. In case of rupture of the spinal cord the child’s death can occur at birth or within hours after birth.
In obstetric palsy is applied splinting of paralyzed limbs of the child in the physiological position, vitamin therapy (intravenous vitamins, Dibazol). 2 weeks later begin a course of massage and light exercise passive movements in all joints in order to restore motor functions.
The treatment of open injuries of the cervical operative. In the hospital carried out medical treatment to the injured, if necessary, a removal of parts of the vertebra (pedicles and processes of the joint), followed by immobilization or traction. At the end of inpatient treatment the patient is often prescribed long-term (up to 12 months) use orthopaedic collar, minimize the consequences of injury.
In addition, as the successful operative treatment of injuries of the cervical it is possible to conduct the replacement, i.e., replacement by implants (endoprostheses) is damaged vertebrae. It should be noted that modern medicine is making great strides in this area. However, for joint replacement surgery, firstly, quite expensive, and secondly, has a number of contraindications such as serious condition of the patient and the presence of purulent infection.
Sometimes the material of the implant can cause an intolerance, the implant may become unstable and cause suppuration. In some cases, the required periodic replacement of the prosthesis (endoprotezirovanie).
Prevention of the disease
It is well known that any disease is easier to prevent than to cure its consequences. This applies to the prevention of whiplash. In General, the prevention of this type of injuries is in compliance with the rules and requirements of safety and labour protection.
In addition, when camping, you should not dive into water, the bottom of which you are not familiar with. You should refrain from diving in a state of alcoholic intoxication.
When making car trips should follow the rules of the road, to ensure the technical serviceability of the car, use the seat belts. It is desirable that the model car was equipped with airbags. The implementation of safety rules when making car trips to help prevent these common injuries as a whiplash injury of the cervical.
With regard to prevention of birth trauma to the cervical spine of the newborn, here are preventive measures consist in the careful and correct implementation of obstetric care at delivery, particularly if the fetus is in breech presentation.