Spinal cord injury

　　Spinal cord injury is often caused by various spinal fractures and dislocations. Spinal fractures and dislocations can occur at any vertebral segment, but 60% to 70% of cases occur at the level of thoracic 10 to lumbar 2. Among them, the segment from thoracic 12 to lumbar 1 is more common, accounting for about 80% of them; the cervical 4-6 vertebral segments and cervical 1-2 are the second most common areas, accounting for about 20% to 25%; the remaining cases are scattered in other vertebral segments.
　　The incidence of spinal cord injury in spinal fracture and dislocation is about 17%左右, among which the incidence of cervical segment is the highest, followed by thoracic and lumbar segments. Cervical 1-2 and occipital-cervical injuries are prone to cause death, and most occur at the scene of injury. Observing from the way of violence, the proportion caused by direct violence is the highest, especially firearm penetrating injuries, almost 100%, followed by hyperextension injuries. If judged from the type of fracture, vertebral body burst fractures are more common. Clinically, cases of severe vertebral bone injury but no obvious symptoms of spinal cord injury, so-called 'lucky' spinal fractures, can also be encountered, which is mainly due to the wide and large vertebral canal.

　　Patients with spinal cord injury due to weak body resistance and most unable to get out of bed can have the following complications:
　　1. Decubitus ulcer: This is caused by long-term pressure on the local area, leading to circulatory disorders in the blood circulation of the area.
　　2. Urinary system infection: Due to the long-term stimulation of the urinary catheter in the body, the defense mechanism of the bladder decreases, resulting in a relatively high infection rate in patients with spinal cord injury.
　　3. Joint stiffness.
　　4. Respiratory tract infection.
　　5. Dysfunction of the autonomic nervous system.
　　6. Constipation.
　　7. Stress ulcer: More common in patients with severe trauma, due to the strong stimulation, it may cause changes in autonomic nervous system function and dysfunction of digestion, leading to stress ulcer and upper gastrointestinal bleeding of the stomach and duodenum.
　　8. Formation of lower limb venous thrombosis: After trauma, the patient's blood is in a hypercoagulable state, venous return is slow, and long-term bed rest is prone to cause lower limb venous thrombosis.

　　The clinical characteristics of spinal cord injury vary greatly depending on the location, degree, range, time, and individual specificity of spinal injury. The specific manifestations are as follows:

　　1. Spinal fracture
　　There is a history of severe trauma, such as falling from a height, heavy object striking the neck or shoulder back, cave-in accidents, traffic accidents, and others. The patient may have back pain, limb dysfunction, cervical and thoracic muscle spasm, and inability to turn over and stand up. Localized posterior prominence deformity can be palpated at the fracture site. Due to the stimulation of retroperitoneal hematoma on the autonomic nervous system, intestinal peristalsis slows down, and symptoms such as abdominal distension and abdominal pain often occur, sometimes needing to be differentiated from abdominal organ injury.

　　Second, combined spinal cord and nerve root injury
　　After spinal cord injury, the movement, sensation, reflexes, and sphincter and autonomic nerve functions below the level of injury are damaged.
　　1. Sensory dysfunction: The pain, temperature, touch, and proprioception below the level of injury are weakened or absent.
　　2. Motor dysfunction: During the spinal shock period, the segments below the level of spinal cord injury show flaccidity and disappearance of reflexes. After the shock period, if there is a transverse injury of the spinal cord, upper motor neuron paralysis, increased muscle tone, hyperactive deep tendon reflexes, and patellar and ankle clonus as well as pathological reflexes appear.
　　3. Urinary sphincter dysfunction: During the spinal shock period, urinary retention occurs, which is caused by the paralysis of the detrusor muscle of the bladder, forming a hypotonic bladder. After the shock period, if the level of spinal cord injury is above the sacral level, an automatic reflex bladder can be formed, with residual urine less than 100ml, but cannot be urinated at will. If the level of spinal cord injury is at the conus medullaris of the sacrum or the injury of sacral nerve roots, urinary incontinence occurs, and the bladder emptying needs to be done by increasing abdominal pressure (by squeezing the abdomen with hands) or using a catheter to empty urine.
　　4. Incomplete spinal cord injury: When there is still some preservation of motor or sensory function at the level of injury, it is called incomplete spinal cord injury.

　　Spinal cord injury is caused by traumatic factors, so there are no effective preventive measures. Paying attention to safety in production and life, and avoiding trauma is the key to the prevention and treatment of this disease.

　　The diagnosis of spinal cord injury, in addition to relying on clinical manifestations, is indispensable with auxiliary examination methods. The commonly used examinations in clinical practice are as follows:
　　1. X-ray examination
　　Routine X-ray films of the spine in anteroposterior and lateral positions, and oblique positions if necessary. When interpreting the films, measure the height of the anterior and posterior parts of the vertebral bodies and compare them with the upper and lower adjacent vertebral bodies; measure the distance between the vertebral pedicles and the width of the vertebral bodies; measure the distance between the spinous processes and the width of the intervertebral disc spaces and compare them with the upper and lower adjacent vertebral spaces. X-rays can basically determine the location and type of fracture.
　　2. CT examination
　　CT examination is conducive to determining the degree of invasion of displaced bone fragments into the spinal canal and the discovery of bone fragments or intervertebral discs protruding into the spinal canal.
　　3. MRI (Magnetic Resonance Imaging) examination
　　MRI (Magnetic Resonance Imaging) examination is extremely valuable for determining the condition of spinal cord injury. MRI can show early edema and hemorrhage in spinal cord injury, and can also show various pathological changes in spinal cord injury, such as compression of the spinal cord, spinal cord transection, incomplete spinal cord injury, spinal cord atrophy, or cystic change, etc.
　　4. Myelography
　　Myelography is meaningful for the diagnosis of old traumatic spinal canal stenosis.

　　Patients with spinal cord injury should consume foods rich in fiber, such as fruits, vegetables, beans, brown rice, whole wheat, etc., which are helpful for improving constipation. Patients should drink enough water of 3000 milliliters per day, which is beneficial for timely bladder emptying and the prevention of urinary tract infections, as well as for softening feces.

　　During the first aid and transportation of spinal cord and spinal cord injury patients, do not use soft stretchers, and it is advisable to use wooden boards for transportation. The specific method is to first extend the two lower limbs of the injured person, and also extend the two upper limbs to the side, place the board on the side of the injured person, and have 2-3 people support the trunk, pelvis, and limbs of the injured person to form an integrated rolling movement to the board. Do not use the method of embracing or lifting the head and legs by one person. For patients with cervical cord injury, the head should be supported and slightly pulled along the longitudinal axis to roll with the trunk. Soft materials should be used to pad and fix the injured person's body between the board. During transportation, observe whether there is any obstruction in the respiratory tract and remove it in time, and check the changes in breathing, heart rate, and blood pressure, etc. The measures for in-hospital treatment are as follows:

　　One, Simple Spinal Fracture
　　1. Mild Vertebral Compression and Stable Thoracolumbar Fracture: Patients can lie flat on a hard bed, with the waist elevated, and can start back extensor exercises a few days later, and can get out of bed to move around after 3-4 weeks.
　　2. Severe Thoracolumbar Compression Exceeding 50%: Closed reduction should be performed, and the patient should wear a plaster corset for 3 months after reduction.
　　3. Cervical Fracture or Dislocation: For mild compression displacement, use mandibular occipital traction bandage for reduction, and fix the head and chest with plaster for 3 months after reduction; for severe compression displacement, use continuous craniocervical traction for reduction, take X-ray films for复查, fix the head and chest with plaster for 3 months after reduction, and those who fail to reduce traction need to undergo open reduction and internal fixation.
　　4. Unstable Thoracolumbar Spinal Fracture: Consider open reduction and internal fixation if the vertebral body compression exceeds more than 1/2, the deformity angle is greater than 20°, or there is dislocation.

　　Two, Spinal Fracture with Spinal Cord Injury
　　Surgical treatment is an important part of comprehensive rehabilitation treatment for patients with spinal cord injury, and its surgical methods include open reduction and internal fixation and decompression surgery.

　　Three, Comprehensive Treatment
　　1. Dehydration therapy: The purpose is to reduce spinal cord edema.
　　2. Hormonal therapy: It has certain significance for alleviating the traumatic response of the spinal cord.
　　3. Some free radical scavengers, such as vitamins and coenzyme Q, calcium channel blockers, lidocaine, and others are believed to have certain benefits in preventing secondary damage after spinal cord injury.