Spinal cord contusion is a variant of spinal cord injury, characterized by the occurrence of reversible (functional) and irreversible (organic) changes in the spinal cord in the form of foci of necrosis, crushing, hemorrhages, leading to partial damage or morphological interruption of the spinal cord.
- Pathological changes can be either primary – at the site of application of the traumatic force, or secondary – due to circulatory disorders and CSF circulation.
- The morphological interruption of the spinal cord can be anatomical (with a divergence of ends) and axonal, when the integrity of the spinal cord is externally preserved, although its conduction systems are destroyed at the level of injury.
- Complete anatomical interruption of the spinal cord is not common.
- Spinal cord injury is not classified according to severity. Depending on the depth of the lesion, a neurological deficit of varying severity is observed.
- The phase of the flow. A spinal cord injury is accompanied by spinal shock (for more details, see Spinal Cord Injury), which masks the true picture of spinal cord injury. Only after the resolution of shock does persistent symptoms appear, reflecting the degree of damage to the spinal cord.
- Conduction disturbance syndrome is the most characteristic manifestation of spinal cord contusion.
- Complete conduction disorder syndrome
- Violation of motor functions in the form of flaccid paralysis, areflexia
- Disorders of all types of sensitivity according to the conduction type (its absence below the level of the lesion)
- Vegetative symptoms: thermoregulation disorders, trophism (dry skin, rapid formation of bedsores)
- Gross violations of the functions of the pelvic organs.
- The syndrome of partial conduction disturbance is characterized by the same disorders as with its complete violation, but at the same time, signs are revealed that indicate the partial preservation of the conduction of the spinal cord (detection of movement or sensory disturbances).
below the level of damage, expressed in varying degrees).
- Complete transverse lesion of the spinal cord (morphological hiatus) is a syndrome of complete conduction disturbance in the acute period and automatism of the distal part of the brain below the level of the hiatus in the later periods. Prolonged priapism and early trophic disorders indicate irreversible brain damage.
- During a neurological examination, it will be necessary first of all to find out whether there is a picture of a complete transverse lesion of the spinal cord or only a partial loss of its functions
- CSF is an admixture of blood; liquorodynamic tests sometimes reveal a different degree of blockade of the subarachnoid space
- Radiography of the spine in 2 projections, myelography
- CT and MRI.
- Ascending medullary edema
- Visceral: occurrence of ascending urinary tract infection, urogenic sepsis, bronchopneumonia
- Formation of bedsores
- Articular contractures
- Deep vein thrombosis, thromboembolism of various localization. Forecast
- Relatively unfavorable. A significant improvement in the condition cannot be expected, since regeneration with inaccurate matching of axon ends is negligible.
- If, in the clinical picture of a complete transverse lesion, at least slight signs of functional recovery do not appear in the next 48 hours, this indicates an organic, rather than functional, nature of the damage, which is considered a poor prognostic sign (irreversible loss of functions)
- The spinal roots, being peripheral neurons, are capable of regeneration, but only in cases where at least the outer shell of the root remains intact. After a complete rupture, the regenerating axons of the central stump are separated from the distal stump, so fusion does not occur.
Synonyms. spinal cord contusion
- S14.0 Contusion and edema of cervical spinal cord
- S24.0 Contusion and edema of thoracic spinal cord
- S34.1 Other injury of lumbar spinal cord