Cervical spine injuries. Kinds. First aid

The neck area has a special anatomical structure and functionality. A small injury can greatly complicate a person’s life, and an awkward turn can lead to injury that is incompatible with life.

Properly provided first aid is also important here. Sometimes inept attempts to alleviate the victim's condition can lead to sudden death or paralysis. In the article we will look at what types of injuries to the cervical spine there are, what principles of first aid exist, and what is strictly forbidden to do if a person has injured their neck.

Damage to ligaments and discs

Independent, i.e. not combined with other injuries, ligament ruptures occur during sudden, spontaneous or uncoordinated movements. In such situations, muscle control is minimal and injury occurs.

Symptoms may vary. This depends on the extent of the neck ligament tear. There are complete, partial rupture and separation of some fibers. Common signs of damage are pain and stiffness in movement. Often, a ligament rupture can mask other, more severe spinal injuries.

Disc damage is common among mature and older people. This is facilitated by age-related changes, which negatively affect the condition of bone and cartilage tissue. At a younger age, a ruptured disc occurs as a result of indirect trauma, heavy lifting, or rapid movements of the neck.

When a disc is damaged, the pain depends on the level and location of the rupture, the degree of prolapse or destruction of the polynosus nucleus.

You should pay attention if:

with slow movements of the neck of small amplitude, pain of varying intensity appears;
pain in the cervical region occurs when coughing or sneezing;
movements are limited;
from time to time sharp “shots” are felt with the forced preservation of a certain position of the head and neck.

People often do not notice such injuries. Symptoms appear some time after the injury (2-3 weeks). However, if pain occurs, it is recommended to immobilize the cervical spine and provide it with complete rest. For severe pain, apply a cold compress.

Publications in the media

Occurs when exposed to a force directed from bottom to top or from front to back. Injuries may vary • Soft tissues of the neck – whiplash type injury • Spinal structures – fractures, vertebral dislocations, torn ligaments, and damaged intervertebral discs • Spinal cord – spinal cord injury syndrome (SCI) due to compression or hemorrhage. Frequency. About 1/4 of spinal cord injuries occur due to excessive extension (hyperextension). Predominant age . Injuries and sports injuries most often occur in young people, with an average age of 30 years; SPSM is more common in the elderly, with a mean age of 53 years. The predominant gender is male. Etiology • Most common - automobile accident • Sports injury • Fall from height • Injury due to assault.

Genetic aspects. Associated with predisposing factors such as HLA-B27-associated ankylosing spondylitis. Risk factors are identified in 65% of patients with SPSM • Narrowing of the spinal canal •• Congenital •• Acquired (previous injuries, osteophytes) • Spinal rigidity •• Klippel-Feil syndrome •• Ankylosing spondylitis. Pathomorphology • Whiplash type injury (data obtained in animal experiments) •• Muscle ruptures (sternocleidomastoid and longus colli muscles) •• Damage to the anterior longitudinal ligament •• Flattening of intervertebral discs and vertebral bodies •• Rare finding - retropharyngeal hematoma • SPSM •• Traditionally, hemorrhages have been thought to occur predominantly in the central gray matter •• Recent reports have shown that white matter lesions are more common, involving the lateral funiculi, especially the corticospinal tract •• Diffuse axonal disruption is a characteristic feature. Clinical picture • Pain in the neck, impaired mobility of the neck • Headache • Paresthesia • Pain in the shoulder, limited mobility of the arm, radicular symptoms • Possible hematomas, abrasions, wounds in the face • SPSM •• Weakness (paresis) in the distal limbs is pronounced stronger than in the proximal ones; in the arms - stronger than in the legs •• Various sensory disorders •• Impaired sphincter tone •• When C8–T1 is involved in the process, Horner's syndrome develops.

Special studies • X-ray examination of the cervical spine is the main method of primary diagnosis •• The X-ray reveals slight extension, swelling of the tissues around the vertebrae due to rupture of the anterior longitudinal ligament •• Fluoroscopy or serial radiography in flexion and extension is carried out only if consciousness is preserved, there is no neurological deficit and severe pain in the cervical spine • CT scan more accurately visualizes the boundaries of fractures and determines the condition of the spinal canal • MRI is the diagnostic procedure of choice for spinal cord injuries; detects damage to ligaments and intervertebral discs, compression fractures of the vertebral bodies • CT myelography is an alternative study to MRI, visualizes tears in the meninges. Differential diagnosis • Intervertebral disc herniation • Arthritis • Radiculopathy • Myelopathy • With CPSM •• Crossed Bell's palsy •• Bilateral lesion of the brachial plexus.

TREATMENT Stationary mode Management tactics Whiplash-type injuries - tactics depend on the severity of the injury • Limitation of activity • Analgesics, muscle relaxants, anti-inflammatory drugs • After the disappearance of symptoms, a control fluoroscopy of the cervical spine in the lateral projection in flexion and extension is indicated. SPSM. Once the condition has stabilized, bed rest and a soft collar are prescribed for 4–6 weeks. After stopping bed rest, the collar is left in place for another 4–6 weeks. Fractures • Surgical decompression followed by immobilization is indicated in the following cases •• Incomplete damage to the spinal cord by bone, intervertebral disc, or caused by vertebral subluxation or hematoma •• Deterioration of the condition or failure of conservative treatment. • Hanging fracture. Traumatic spondylolisthesis of the axial vertebra develops as a result of a fracture through the CII pedicles, often combined with a subluxation of CII over CIII •• Usually these fractures are stable, they are treated with sterno-occipital-frontal orthopedic straightening •• The fracture is considered unstable if the displacement due to subluxation of CII is above CIII is more than 50% of the size of CIII or an excessive bend of CII over CIII is detected ••• Treat with an immobilization vest for 8–14 weeks, then a control radiography of the cervical spine is performed in the lateral projection in the position of flexion and extension ••• If the fracture is stable , a rigid collar is prescribed for 8–12 weeks. • Fractures of the odontoid process. Treatment depends on the type of fracture •• Type I - a fracture passing through the apex, may be unstable and require surgical osteosynthesis •• Type II - a fracture passing through the base of the neck, usually unstable; when using only immobilization, it does not heal in 30% of patients, especially if the displacement is more than 5 mm, and the patient is older than 7 years •• Type III - the fracture passes through the body of CII, usually stable; immobilization with a hoop is indicated for 8–14 weeks, then a rigid collar for 8–14 weeks. • Extension fractures CIII-CVI •• If stable, a rigid collar is prescribed for 8-14 weeks •• If the fracture is unstable, a hoop brace is used, then a series of lateral radiographs are taken in the neck flexion and extension position; if the fracture remains unstable, osteosynthesis is performed •• After surgery, radiography is periodically performed until trabecularity appears at the site of the former fracture. Surgical treatment of SPSM • In acute cases, surgical intervention can cause deterioration of the condition and increase the risk of complications, therefore, if possible, it is not used • The operation is performed if, after a temporary improvement, the patient’s condition worsens again • Optimally, surgical intervention is performed after stabilization or improvement of neurological parameters • Fractures : see Management tactics • Rest and immobilization are indicated until the pain disappears; then there may be a need for rehabilitation measures.

Drug therapy . For SPSM - methylprednisolone 30 mg/kg IV over 15 minutes, after 45 minutes IV drip at 5.4 mg/kg/hour for 23 hours. Treatment should begin in the first 8 hours after injury. Observation • Control radiography every 3-4 weeks for 3 months (until bone integrity is restored) • Then the hoop is replaced with a hard collar, and after 3 months - with a soft one. Complications • Non-union of fracture • Fracture instability • Complications of orthopedic straightening. The course and prognosis vary depending on the initial neurological status • With whiplash type injury, the condition of most patients fully recovers, minor symptoms disappear within 6 months •• For recovery from severe injuries without involvement of the intervertebral disc, 20–21 months are required •• 30 months - recovery time after injuries with degenerative changes •• 2 years after the injury, 42% of patients fully recover, 15% report a feeling of slight discomfort, 43% have residual symptoms that affect their ability to work • SPSM •• The prognosis is better in young patients •• In the majority in patients, muscle strength is restored within 2 weeks •• The functions of the legs, intestines and bladder are restored first •• First, muscle strength is restored in the distal limbs, later in the proximal ones •• Restoration of the functions of the upper limb usually does not occur completely (fine movements of the fingers are not fully restored) •• With a concussion of the spinal cord without hemorrhage into the brain tissue in 50% of patients, the degree of restoration of strength and sensitivity is sufficient for independent movement, although some spasticity remains • Displaced fracture •• After fractures due to hanging in 93–100% of patients, consolidation fractures occur after 8–14 weeks with immobilization •• Fracture of the odontoid process (type III) - consolidation in 90% of cases with immobilization. Prevention. Use of safety equipment (for example, seat belts and head restraints in cars). Synonym. Hyperextension neck injuries Reduction. Spinal Cord Injury Syndrome

ICD-10. S14 Nerve and spinal cord injury at neck level

Note. Spondylolisthesis is a displacement of a vertebra relative to another located underneath it; often anterior displacement.

Whiplash neck injury

The name of the injury was introduced by the American N. Crowe. The bottom line is that with a sharp forward movement and quick extension back, the neck movements are similar to the swing of a whip. As a result, injury to the intervertebral joints and cervical ligaments occurs.

A fairly common injury. It can easily be obtained in such ordinary situations as diving into water, playing sports, or an unexpected fall. With sudden impact in car accidents, there is also a high chance of suffering a whiplash injury to the neck.

Damage can be mild or severe:

In case of severe injury, pain symptoms occur instantly. The victim feels a sharp, piercing pain that can spread throughout the entire spine. Dizziness, nausea, and vomiting appear. Possible vision impairment. In some cases, a person may feel pain in the chest or lower back, the so-called wandering symptom.

With insignificant impact force, mild injury to the cervical spine occurs. Often the victim does not feel any unpleasant symptoms at the time of injury. Discomfort, pain, and nausea may occur several hours or days after the traumatic exposure. Sometimes the victim feels numbness and decreased sensation in the limbs.

In mild cases, first aid is aimed at eliminating discomfort. Any analgesics are suitable for this. In cases of severe whiplash, the cervical spine must be secured using a special collar. You can take painkillers and anti-inflammatory drugs.

Cause of pain

It is usually not possible to accurately determine the cause of neck pain until several days or weeks after a car accident. It is known that muscles and ligaments become stretched and likely become inflamed after an injury, but the condition usually resolves spontaneously within six to ten weeks. Pain that lasts longer is usually the result of more serious problems, such as disc or facet joint damage.

Facet joint pain is the most common cause of chronic neck pain after a car accident. The pain may be limited to the facet joints or may be associated with disc pain. Facet pain is typically located to the right or left of the center of the back of the neck. The area may be tender to the touch, and facet pain may be mistaken for muscle pain. Unfortunately, it is difficult to determine whether facet joints are involved using X-rays or MRI. The only reliable way to confirm the role of the facet joints in pain is to perform a medial branch block.
Disc injury from whiplash can also lead to chronic neck pain. The disc allows the neck to move, but at the same time keeps the neck from excessive movement. The outer part of the disc (called the annulus fibrosus) can be torn from a whiplash injury. Typically, this tear will heal, but not in all patients. In this case, the disc becomes weaker and leads to pain during normal activities. The pain comes from the nerve endings in the annulus fibrosus. The disc is the primary cause of chronic neck pain in 25% of patients, but the pain may be associated with facet joint pain. Disc herniation and compression of nerve roots appear much less frequently and, in such cases, pain in the arm prevails over pain in the neck.
Strained muscles in the neck and upper back can cause severe pain. However, there is no conclusive evidence that neck muscles are the main cause of chronic neck pain. However, muscle damage can occur when muscles have to endure greater strain to protect damaged discs, joints, nerves, or when posture is poor.
Compression of the roots and spinal cord by disc herniation or osteophytes is possible. This usually results in arm pain, but there may also be neck pain.

Vertebral body fracture

The cause of such an injury is strong compression (squeezing) of this area or a strong spontaneous blow.

Characterized by the following symptoms:

with a fracture of 1 vertebra (atlas), pain is felt at the site of injury, and also spreads to the back of the head and parietal region;
Damage to the 2nd vertebra is characterized by discomfort when turning the head from side to side. Numbness of the fingers or temporary paralysis are possible;
injury to the 3rd vertebra leads to pain and severe limitation of movement;
the muscles in the area of the fracture often swell, become hard and swollen.
in rare cases, breathing difficulties, headaches, increased heart rate and dizziness may occur.

The most complex fracture is the one with splinters. In this case, touching the head, pulling or turning is prohibited. The victim should be placed on a hard, horizontal surface. Fix the neck in the position in which the head is located. You can put a collar-type cushion under your neck.

Types of dressings used for head and neck injuries

Applying a bandage to the neck or head may be necessary in various cases - to stop bleeding, for immobilization, for cuts, bruises or scratches. At the same time, the type of bandage, as well as the material used for it, may be different. Particular attention must be paid to wounds and injuries associated with violation of the integrity of the skin, as well as bleeding and bleeding wounds, since in these cases there is a possibility of infection in the wound.

Therapeutic dressings are specially impregnated with various ointments and medicinal agents that help accelerate tissue healing. Protective, in turn, protect the site of injury or damage from infection and suppuration. Applying a pressure bandage is one way to stop bleeding.

Content:

Types of dressings used for head and neck injuries
First aid and dressing for neck injuries
Bandages for head injuries: basic first aid

What can a bandage be made from? The most commonly used dressing material is medical gauze. Its advantage is its availability in any pharmacy, sterility and low price, as well as the naturalness of the material itself. If gauze is not at hand, and assistance to the victim must be provided urgently, any clean and natural fabric, preferably white, will do. In order to ensure at least minimal disinfection, the fabric should be ironed on both sides.

In order for the fabric or gauze to have an effect on blood clotting and promote wound healing, it can be soaked in a special ointment, for example, Levomekol or Baneocin. A layer of sterile cotton wool or gauze must be placed between the wound surface and the bandage.

Contusion of the cervical spine

A bruise differs from other types of injuries in that only external damage occurs. The organ itself does not receive strong traumatic effects.

It is characterized by the following features:

the pain is often aching and dull in nature. It occurs at the site of the bruise and spreads to the back of the head. This occurs due to damage to the nerve fibers or roots of the cervical spine;
due to a short-term disruption of the connection between the organ and the central nervous system, neurological disorders may be present (paralysis, decreased muscle strength);
breathing problems;
muscle reflex weakens;
confusion, hearing impairment;
temporary loss of coordination. Often, after a severe injury, the victim may experience an unclear gait and uncoordinated movements.

The danger of such an injury is that a hematoma may develop as a result of the blow. It can lead to stroke due to compression of the arteries. In such cases, the application of ice or a bottle of cold water is recommended. Subsequently, contact and examination by a specialist.

General rules of first aid

Examine the victim. Even if external damage is not visible, this does not indicate the absence of injury. Determine the location of the impact, clarify the possible force and direction of the traumatic force.
Place the victim on a hard, level surface.
Immobilization of the cervical spine is carried out using a corset. Among the available means, you can make a Shants collar - a special tire in which the height of the front part is greater than the back. Cardboard and a soft rag or cotton wool are suitable for this. Fixation is done using a bandage. Immobility in the neck area will reduce pain and also avoid serious complications in the event of fragments from a fracture.
Call a team of medical workers.

The person who provides first aid should also know what is strictly prohibited to do in case of injuries to the cervical spine.

Try to turn your head or stretch your neck on your own in case of an unnatural position.
Try to get the person into a sitting position.
Put on your feet.
If swallowing is impaired, medications, including liquid form, should not be given.
Pulling on limbs.
Move the victim in a sitting position.

Ignorance of such things can lead to the sudden death of the victim or, at a minimum, lifelong disability.