10.1. Spinal injuries
10.1.1. Types ofspinal injuries and their diagnosis
Injury to the spine constitutes a significant threat, as it can lead not only to disability, but also to death. 10% of patients show neurologic complications due to underestimation of the severity of injury and inadequate care at the prehospital stage.
The mechanism of spinal injury can be direct or indirect; the indirect mechanism (flexion, extension, rotation, vertical compression) is more common. In adults, vertebrae in the transition area of one physiological curvature to another are more often injured: lower cervical and upper thoracic, lower thoracic and upper lumbar vertebrae. Vertabral fracture in the middle thoracic area is more typical of children. Dislocations are more common in the cervical region, while the thoracic and lumbar area mostly sustain fractures and dislocation fractures.
There are stable and unstable fractures. With unstable injuries, there is a tendency to misplacement of vertebral bodies with a the threat of compression of the dural sac contents. Depending on whether the spinal cord is affected or not, spinal injuries can be complicated and uncomplicated.
Uncomplicated injuries are characterized by non-reliable signs, so the preliminary diagnosis is based on probable signs: local tenderness, presence of bruises or wounds (indicating the place of traumatic force) application, forced position, restriction of painless movements, muscle tension (in the thoracic spine this tension is called Kornev?s, or rein sign), painful palpation of the spinous processes of the vertebrae.
Injury to the cervical spine is also characterized by instability of the head: at a severe degree the victim is unable to hold his head (?guillotine? sign); at a moderate degree the victim supports the head with his hands (Thomsen?s sign); at a mild degree the head is almost motionless due to muscle tension (?statue head?).