Rehabilitation after a spinal injury - what is possible and what is not, recovery period and timing at the MEDSI rehabilitation center

Causes

The spine is a complex structure consisting of vertebrae, connective tissue joints, muscles, and intervertebral discs. Regardless of the severity, any spinal injury is considered a serious illness. Spinal injuries occur as a result of:

• Falls from any height. Loss of stability and imbalance can lead to dangerous injuries. Even falling from your own height is dangerous, not to mention falling from more dangerous balconies, stairs, scaffolding, trees or roofs.
• Mechanical impacts as a result of road accidents. Bruises and fractures occur due to excessive compression and inertial forward movement of the head.
• Compression. Injury occurs when a heavy object falls on a person from above. Most often, compression of the spine occurs as a result of the collapse of any structures, industrial emergencies, or beatings.
• Pathological processes in the body. Damage to the spine is observed in older people as a consequence of the rapid progression of osteoporosis, degenerative bone diseases, and degenerative changes.

Spinal cord injury

Sometimes a spinal injury extends to the spinal cord. This may be due to external factors such as a severe contusion or a compression fracture of the cervical spine, although the injury can occur in any part of the spine.

The following signs usually indicate a spinal cord injury:

• numbness or tingling in the limbs;
• pain and stiffness in the spine;
• signs of shock;
• inability to move limbs;
• loss of urinary control;
• loss of consciousness;
• unnatural head position.

Spinal problems are often the result of accidents or violent acts. Main causes of injuries:

• a fall;
• diving in shallow water (consequences of hitting your head on the bottom of a reservoir);
• trauma after a car accident;
• jumping;
• head injury during a sporting event;
• electric shock injuries.

Types of spinal injuries

Injuries to the spinal column are divided into open and closed. Depending on the location - for injuries of the cervical, thoracic, lumbar spine. Based on the nature of the damage, the following are distinguished:

• spinal bruises;
• ruptures of joint capsules, ligaments without displacement of vertebral bodies - distortions;
• vertebral arch fractures;
• vertebral body fractures;
• fractures of the transverse, spinous processes;
• dislocations and subluxations;
• fracture-dislocations;
• spondylolisthesis is a displacement of the body of the superior vertebra relative to the inferior one as a result of a traumatic rupture of ligaments.

Of the total number of spinal injuries, stable and unstable injuries are distinguished. With stable injuries, the traumatic disorder does not get worse, but with unstable injuries, there is always a threat of developing a more severe condition. Most often, these injuries occur with combined damage to the posterior and anterior sections of the vertebrae.

Traumatological classification implies the division of all spinal column injuries into large groups:

• Uncomplicated - in which the integrity of the spinal cord is not compromised.
• Complicated – with spinal cord injury. Depending on the type of spinal cord injury, there are: reversible (concussion), irreversible (concussion, bruises), compression myelopathy (the result of hematoma, swelling).

Treatment

In case of spinal injuries, all measures should be taken to prevent damage to the spinal cord. The patient is taken to the hospital on a board. If the cervical spine is damaged, a collar is applied. A patient with spinal damage can only move in a wheelchair.

The treatment of spinal injuries is selected by the doctor, taking into account the degree of damage. It may be operational or non-operative. Most injuries do not require surgery.

The patient should remain in bed and wear a corset. For neck injuries, it is worn for 8-12 weeks, and in other cases - 12-24. During this time, the fracture will consolidate and the bone will be able to withstand the load. If the patient refuses to wear a corset and surgery, or surgery is contraindicated for him, he is required to remain in bed.

Anti-inflammatory and painkillers, as well as antibiotics, are prescribed for spinal injuries. Patients are often prescribed intravenous infusions. If sleep deteriorates as a result of severe pain, it is recommended to take sedatives.

Surgery is not recommended for morbid obesity, severe deformity, internal organ dysfunction, heart problems, or hemorrhagic shock. According to medical research, in the later stages of the disease, surgical treatment is preferable; the use of conservative methods can cause chronic pain.

Surgically stabilizing the spine prevents further damage. When the spinal cord is compressed, decompression with removal of pathological structures is the only method of alleviating the patient’s condition.

Indications for surgery for spinal lesions are:

• unstable ligament injury that did not respond to conservative therapy;
• multiple injuries;
• disruption of the pelvic organs;
• spinal cord neoplasms;
• progressive spinal deformity;
• skeletal instability in combination with neurological abnormalities;
• spinal cord compression;
• combination of several injuries;
• severe pain that is not relieved even by prescription painkillers;
• lack of effect from drug therapy.

Today, operations performed on the spine leave virtually no side effects. They are minimally invasive and in most cases the patient is discharged from the hospital after a few days. The damaged area is fixed with an implant. Then they begin to merge this area with the bone graft. In this way, the damaged area is retained with the implant.

For dislocations of the cervical spine, the use of closed reduction is practiced. With this technique, traction forceps are installed. The outcome of the operation is favorable, neurological disorders are very rare. However, reduction has a number of contraindications, among which are:

1. Cervical spine injury accompanied by distraction.

2. Craniocervical dissociation.

To prevent infectious complications, the victim is prescribed a course of antibiotics before surgery.

For unstable and highly mobile vertebrae, vertebral arthrodesis is performed. This operation prevents spinal cord injury.

After spinal surgery, the patient must undergo a rehabilitation course. The patient is recommended to perform physical exercises to maintain muscle tone and strengthen the spine. This course is selected individually by a physiotherapist. However, it must be taken into account that it sometimes takes several months for the patient to regain mobility.

Symptoms

The severity of the clinical picture is determined by the type of injury. Spinal bruise is characterized by:

• extensive subcutaneous hemorrhage in the area of ​​traumatic impact;
• diffuse soreness;
• swelling of the skin over the corresponding section;
• restriction of physical activity.

When fractures of the transverse processes of the vertebrae occur:

• severe pain in the soft tissues around the injury site;
• painful sensations intensify when turning the body;
• stuck heel syndrome - the patient lying on his back cannot lift his straightened leg off the surface.

Damage to the cervical spine is manifested by intense pain in the head, a feeling of numbness in the arms and legs. The patient reports memory impairment. Neurological symptoms immediately appear: vomiting, ringing in the ears, impaired tendon reflexes. In severe cases, paralysis occurs.

When the atlas (I cervical vertebra) is damaged, the following is observed:

• impaired movement in the neck area;
• pain in the upper neck radiating to the back of the head;
• nausea;
• loss of consciousness;
• visual impairment;
• convulsions.

In severe cases, when fragments are displaced, the patient dies as a result of compression of the medulla oblongata.

Fractures, fracture-dislocations, subluxations are manifested by an increase in the interspinous spaces, and sometimes bulges appear in the area of ​​injury. There is always a limitation of mobility. The back muscles are tense. All types of sensitivity are impaired.

Spinal injuries accompanied by spinal cord injuries present with severe symptoms. In case of damage at the level of the IV cervical vertebra, the victim rapidly develops diaphragmatic paralysis, which leads to respiratory arrest and death.

In some cases, patients with spinal injuries experience dysfunction of the pelvic organs. Spinal cord rupture causes massive intestinal bleeding. Pathological changes in local blood flow and lymph movement quickly lead to the formation of bedsores.

Injuries of the sacrum and coccyx

Bruises in this area of ​​the spine are accompanied by the formation of hematomas, which in the future, if left untreated, lead to partial or complete loss of leg mobility. At the site of injury, patients note pain, aggravated during defecation and urination.

When the conus medullaris, which is the terminal part of the spinal cord, is damaged, the victim complains of urinary retention or incontinence. With this pathology, the tone of the anal sphincter decreases and sexual function is impaired.

The disappearance of tendon reflexes and the appearance of problems with sensitivity in the legs are a symptom of injury to the cauda equina.

Consequences

The severity of post-traumatic complications depends on the characteristics of injuries to the spine and spinal cord, the timeliness of first aid and the usefulness of subsequent treatment. The most common negative consequences are:

• acquired instability of the spine;
• intense pain syndrome;
• chronic inflammation in the area of ​​injury;
• post-traumatic osteochondrosis;
• decreased muscle tone;
• muscle fiber atrophy;
• decreased physical strength and endurance;
• reduction of the lumen of the spinal canal;
• combined deformation of the spinal column in the form of kypholoscoliosis;
• disorder or complete loss of sensitivity;
• spastic manifestations;
• complete paralysis of the body;
• insufficiency of functions of internal organs.

In addition to physical changes, patients often experience psychological disorders. After spinal injuries, patients need long-term treatment and rehabilitation, which entails a complete change in their usual lifestyle, giving up sports and hobbies.

The inability to independently care for one’s needs and perform simple hygienic procedures causes neuroses and depressive disorders.

Diagnostic features

The nature and location of the victim’s injuries are determined after a neurological examination. The victim's metacarpal, knee and Achilles reflexes are checked. After a visual examination, the patient is sent for an x-ray, which shows the dislocation of the vertebrae and depicts fractures.

The study is carried out in lateral and posterior projections. However, this method does not always determine pathology. CT gives a more accurate result. The procedure is recommended if the patient is in critical condition and requires emergency care. This technique is effective because it shows damage to soft tissue and bones.

The integrity of bone tissue and the condition of the spinal cord is reflected by MRI. The procedure reveals abnormalities that may not be visible on x-rays.

If osteoporosis is suspected, densitometry is required. This technique shows the level of calcium in the blood. The examination lasts about 30 minutes, while the patient must remain motionless.

EMG is used to assess the extent of nerve damage. Since spinal injuries cause disturbances in the functioning of internal organs, the patient undergoes an ultrasound and ECG.

The results of instrumental diagnostic methods must be confirmed by a blood test, which displays the concentration of calcium and C-reactive protein.

Treatment of spinal injuries in Naberezhnye Chelny

To treat spinal injuries, a set of measures is used, which includes:

• medications;
• physiotherapeutic procedures;
• surgery.

At the Center for Rehabilitation Medicine in Naberezhnye Chelny, a neurologist draws up individual therapeutic programs for each patient. Depending on the degree of stability and severity of the injuries, the patient is prescribed:

• bed rest;
• immobilization of the spine, which involves maintaining the position of the body on the backboard, wearing special fixing collars and corsets;
• according to indications – realignment of the vertebrae;
• skeletal traction;
• thermal procedures.

A mandatory element of therapy is adequate pain relief, the prescription of anti-inflammatory drugs, and agents to accelerate regenerative processes.

In severe cases, patients who have sustained a spinal injury are advised to undergo surgical treatment and reconstructive operations.

First aid for spinal injury

In case of spinal injury, a favorable outcome is possible if the patient receives medical care in a timely manner. People with such injuries need to be hospitalized, so an ambulance is called first. The victim must be immobilized by placing him on a flat surface. It is forbidden to lift or move the victim, or turn his head. It is also prohibited to adjust the vertebrae yourself.

Doctors carry a victim with a spinal injury on a soft or hard stretcher. In the first case, the patient must lie face down, and in the latter he is placed on his back.

Prevention

Unfortunately, spine and spinal cord injuries are unpredictable, but the risk of injury can be greatly reduced by following simple safety precautions.

• You should always wear a seat belt while riding in a car.
• When playing sports, you must wear appropriate protective equipment.
• Do not dive in unfamiliar bodies of water
• Strengthen the muscular system to provide proper support to the spine.
• Do not drink alcohol while driving.