Spinal cord injuries
The development and severity of spine trauma with concomitant spinal cord injury depend on many factors: the age of the patient, the presence of previous diseases of the musculoskeletal system, the mechanism of injury and the impact force. It should be borne in mind that at the time of injury, the position of the spinal cord differs from that seen on radiographs after trauma. In fractures of the spine with displacement of bone fragments, spinal cord injury occurs in about 15% of cases, with cervical injuries accounting for 40%. Careful examination of patients with spine trauma is extremely important - often it helps to speed up the recovery process. Despite the fact that CT and MRI significantly expand the diagnostic capabilities, a simple radiography method still remains to be used to study the first line. To determine the location of damage, a series of X-ray photographs of good quality is sufficient.
Preliminary diagnosis
In some patients with cervical spine trauma at the initial stages, it is not possible to diagnose a fracture of the second cervical vertebra. Thus, if a patient enters with suspicion of spinal trauma and is unconscious, radiographs of the whole spinal column, and if necessary, CT and MRI, should be performed. CT can more accurately determine the localization of the fracture and detect bone fragments in the spinal canal. With trauma, spiral CT is of particular importance - it allows you to speed up the diagnosis and put a more accurate diagnosis. MRI increased the diagnostic capabilities for spinal trauma. This method is indispensable for detecting soft tissue and spinal cord injuries.
Cuneiform fracture
Traumas of the thoracic and lumbar vertebrae are quite common. They arise as a result of excessive stress on these sedentary and inflexible structures. The presence and type of fracture can be determined by simple radiography. However, CT and MRI may be required to determine the extent of damage. A computer tomogram shows the displacement of bone fragments anteriorly and their wedging into the spinal canal (shown by arrows). Wedge-shaped compression fractures of the back of the thoracic and lumbar vertebrae are characterized by instability. To prevent further damage to the spine and spinal cord, an internal fixation is necessary.
Volume CT
New research methods, in particular spiral CT, make it possible to obtain a three-dimensional image of the spine. They are often used before surgery for combined injuries of the spinal column. If the fracture site is unstable, immediate surgical intervention is required, during which the internal fixation of the fragments is performed.
Spinal cord injury
Different parts of the cervical spine have anatomical and biochemical features; on radiographs they look different. These features also affect the clinical picture of the lesion and the extent of soft tissue damage. Changes in soft tissues develop due to edema and hemorrhage; they can be detected by MRI.
Epidural hematoma
Direct damage to the spinal cord in the acute stage can lead to its edema or bruise, as well as the development of bleeding. With trauma of the cervical spine, damage to the blood vessels of the dura can occur with the development of a hematoma (blood clots), which compresses the dorsal
Rupture of the spinal cord
Severe injuries are often accompanied by a rupture of the spinal cord. Usually this happens when the spine is excessively strong. This trauma leads to the development of chronic neurological disorders. The degree of impaired function depends on the level of damage to the spinal cord.