Spinal injury

　　Any violence that can cause excessive flexion, extension, rotation, or lateral flexion of the spine can cause spinal injury. During normal periods, most patients with spinal fractures and dislocations are caused by high-altitude falls, where the upper body weight adds force, causing excessive flexion of the spine; or heavy objects falling from a height on the patient's head or shoulder and back, which can also cause excessive flexion of the spine, leading to fractures and dislocations of the spine. Some abnormal situations, such as traffic accidents, collapses, earthquakes, explosions, diving, and sports skills, are also common causes of spinal injury.

　　The vast majority of spinal fractures and dislocations occur at places with a large range of motion and a small degree of motion in the spine, which are also the transition areas from physiological anterior convexity to posterior convexity, such as fractures and dislocations at C1-2, C5-6, T11-12, L1-2, and L4-5, which are the most common, accounting for more than 90% of spinal fractures, while fractures in the thoracolumbar segment (T11-L1, 2) account for about 2/3 to 3/4 of spinal fractures.

　　The traditional classification is based on the type of injurious force, such as flexion type, extension type, rotational type, and longitudinal pressure injury, etc. This traditional classification method is not ideal because one force can cause more than one type of spinal injury, and the old classification method does not help in the selection of treatment methods. Canadian Armstrong, integrating his own experience and the classifications of some Western authors, proposed a classification based on the morphological damage, dividing spinal fractures into seven types. Each type has its unique characteristics and is associated with specific treatment methods. The new classification method makes the treatment of spinal fractures more scientific. The characteristics of each type are described as follows:

　　7. Compression fractures

　　Compression fractures are caused by anterior or lateral bending forces, the most common being anterior wedge fractures with reduced anterior vertebral body height. In addition, there are lateral compression fractures, where the heights on both sides of the vertebral body are different. These wedge changes often accompany injuries to the vertebral endplates and intervertebral discs, and the intervertebral disc can be compressed into the vertebral body. However, the height of the posterior edge of the vertebral body in compression fractures remains unchanged, which is different from rupture fractures.

　　5. X-ray examination of rotational injuries

　　The X-ray examination of rotational injuries shows one vertebral body rotating on another. Sometimes, it can be seen that the intervertebral space narrows, mainly due to injuries to the annulus fibrosus and nucleus pulposus. The upper angle of the anterior edge of the next vertebral body can be torn off a small piece by the annulus fibrosus, but the vertebral height remains unchanged. A few cases only have narrowing of the intervertebral space without annular fibrosis tear.

　　3. Rupture fractures

　　Rupture fractures are caused by violent forces acting along the longitudinal axis of the body. The intervertebral disc is compressed into the vertebral endplate, entering the cancellous bone and causing injury. The vertebral body cracks like an 'explosion' from the center, pushing the fragments in all directions, with posterior vertebral body edge fractures and fragments piercing into the spinal canal. The distance between the pedicles is cracked and widened. It often accompanies longitudinal fractures of the posterior vertebral plates, and the larger the anterior vertebral body crack, the more obvious the vertebral plate fracture. Sometimes, there is only an endplate fracture within the vertebral plate, which can only be detected by CT scan. Rupture fractures can also be divided into five types:

　　1. There are both upper and lower endplate injuries, accompanied by posterior vertebral body fragments piercing into the spinal canal, compressing the spinal cord, and causing neurological symptoms.

　　2. Fracture of the upper half of the vertebral body, with compression of the posterior part of the vertebral body, a fracture fragment rotates into the spinal canal, this type is the most common.

　　3. Injury to the inferior vertebral endplate.

　　4. Explosive fractures combined with rotational fractures, in addition to the characteristics of explosive fractures, there are also rotational spinous process deviations to one side;

　　5. Explosive fractures combined with lateral compression fractures, the fracture line obliquely crosses the vertebral body, the distance between the vertebral pedicles is widened, the heights on both sides of the vertebral body are different, and it often accompanies multiple transverse process fractures. This type is the most unstable. The main characteristics of explosive fractures are: widened interpedicular distances, posterior vertebral body compression, reduced height, and widened vertebral transverse diameter. Almost all explosive fractures have neurological symptoms.

　　IV. Shear fractures

　　Shear fractures, also known as slice-like fractures (slicefracture). They are often caused by flexion and rotation forces. All ligaments in the anterior and posterior parts of the spine are torn, and there may be fractures of one or both sides of the small joints, transverse processes, and pedicles, but the vertebral bone destruction is not obvious, and the vertebral height remains unchanged. However, the rotational shear force can tear off a small piece of bone from the superior margin of the next vertebral body, just like cutting off a thin slice. Since all structures are almost completely transversely cut, the fracture height is highly unstable, and patients often suffer from complete paraplegia. X-ray films show the characteristics of 'sliced' fracture fragments and widened vertebral spaces.

　　V. Posterior vertebral body fractures

　　Posterior vertebral body fractures, also known as seatbelt fractures (seatbelt fracture). This fracture was first described by Chance in 1948, hence the literature often refers to it as the Chance fracture, which is a type of flexion extension fracture. The typical injury mechanism is that the seat belt of a car is fastened around the patient's waist and abdomen. When a car traveling at high speed suddenly decelerates or collides, the trunk above the seat belt pivot point bends forward, and the forward thrust also produces a force that pushes a forward transverse process, then it pierces a threaded rod and tightens the nut to apply pressure and fix it. It should be pointed out that for those with widened posterior vertebral disc spaces and avulsion fractures, it indicates disc injury. Sometimes, after using the Harrington compression technique to reduce the fracture, neurological symptoms may appear. This is due to the herniation of the damaged intervertebral disc into the spinal canal and compressing the spinal cord. For such fractures, the injured intervertebral disc should be removed first before compression reduction.

　　It is obvious that CT has many advantages over plain X-ray films in the diagnosis of spinal traumatic fractures that cannot be compared. However, it cannot replace routine X-ray film examination. Only by closely combining both can the reliability and accuracy of the diagnosis of spinal traumatic fractures be improved. It provides more detailed and important information for the correct clinical treatment of spinal traumatic fractures and postoperative evaluation:

　　1. Observe the injury and do not 'support sitting and patting'.

　　People have a habit of trying to help someone up when they see them fall and injure themselves. Especially for those who have lost consciousness, the common method is to 'support sitting and pat while calling for help' to wake them up. In fact, this is a very dangerous action. It is absolutely not allowed to move the injured person without first understanding the severity of their injuries. The first thing the rescuer on the scene needs to do is to observe the injury. If the head, chest, spine, and pelvis of the injured person are injured, they should not change their position arbitrarily.

　　2. Traction straightening, do not bend 'carry a bag'

　　For any suspected head and neck spinal trauma, try to stay still on the spot and wait for medical personnel; when moving the injured person, the spine should be kept in a traction straightening state, so that even if there is vertebral fracture, it will not cause further injury to the spinal cord within the spinal canal. It is absolutely forbidden to bend the spine, taking the 'carry a bag' method of lifting the sacral area with one person and the lower limb with another person, which may cause the fragments of vertebral fractures to stab the spinal cord and nerve.

　　3. Axial flipping, do not rotate 'twisted herringbone'

　　For any suspected spinal injury, when turning over, the head, neck, trunk, and lower limbs must be flipped uniformly along the same axis, and it is absolutely forbidden to flip over in a 'twisted herringbone' manner. This may twist or crush the spinal cord at the fracture site, leading to or aggravating paraplegia. Therefore, at least three people should exert force simultaneously when turning over the injured person, keeping the spine in the axis position and flipping the position at the same speed.

　　4. Hard board immobilization, do not use canvas 'soft stretcher'

　　Before transporting the injured person, it is necessary to immobilize the injured person at the original location, and the injured person should be immobilized on a hard wooden stretcher for transportation, and it is absolutely forbidden to use canvas soft stretchers to transport the injured person.

　　5. Observe breathing, do not ignore 'respiratory paralysis'

　　Spinal trauma is most likely to cause high-level quadriplegia with respiratory muscle paralysis (including chest wall muscles, diaphragm) and affect breathing, and vertebral fractures are most likely to cause secondary injury. Some patients originally had simple vertebral fractures without spinal cord injury and could breathe, but if the spinal cord is accidentally injured again during the rescue process, it can lead to difficulty in breathing or cessation. If artificial respiration is provided before the heart stops, it is still possible to maintain life. Therefore, in the rescue of neck trauma, special attention should be paid to observing the patient's breathing to prevent respiratory arrest and endanger life.

　　6. Do not let the injured person 'go around in circles' for specialist consultation

　　For patients suspected of having spinal trauma, they must be sent directly to a hospital with orthopedic department (with spinal surgery department even better), to achieve a one-stop service of examination → diagnosis → surgery → rehabilitation treatment, and not to transfer between hospitals without orthopedic specialty conditions, repeated examinations and consultations. Nowadays, there are many hospitals with CT equipment, but not many can professionally handle spinal cord injuries. It should be known that spinal (especially cervical spine) examinations, photography, and other operations without the guidance of professional doctors are extremely dangerous, and a mistake can cause respiratory arrest or lifelong disability and other regrets.

　　Displaced fractures were found in 27 cases, with radiographs showing vertebral fractures accompanied by dislocation or subluxation. Vertebral displacement on CT can be determined according to the 'double ring' sign. CT can clearly show the odontoid process of the cervical vertebra, fractures of the vertebral facets, and dislocations. It can also show the relationship between the atlanto-axial joint, and whether there is dislocation or subluxation of the joint can be clearly displayed. The three-column concept of the spine is applicable to CT examination. The anterior column includes the anterior longitudinal ligament, the anterior half of the vertebral body, and the anterior fibrous ring; the middle column is the posterior half of the vertebral body, the posterior fibrous ring, and the posterior longitudinal ligament; the posterior column is composed of the bony structures of the appendages, the synovial capsules of the small joints, the yellow ligaments, the interspinous ligaments, and the supraspinous ligaments.

　　Dietary structure should be reasonable:

　　1. Firstly:Moderate drinking and scientific tea drinking can bring vitality to the spine, but it is important to maintain a balance. Excessive drinking can affect calcium and phosphorus metabolism and worsen osteoporosis.

　　2. Secondly:Milk and bone broth are rich in calcium and phosphorus, which can improve calcium and phosphorus metabolism and achieve the purpose of preventing osteoporosis.

　　1. In patients with spinal cord injury, the incidence of impotence is related to the degree and level of spinal cord injury. Severe injury above C5 in the cervical spine can cause respiratory paralysis, which is often fatal. Injury located at or above C4 to C5 in the cervical spine can cause complete quadriplegia. If located between C6 and C7 in the cervical spine, it can cause paralysis of both legs, wrists, and hands. If the injury is located between T11 and T12 in the thoracic spine, it can affect the muscles above and below the knees. All these injuries can cause varying degrees of sexual dysfunction, such as erectile dysfunction and impotence. When the injury is located between T12 and L3 in the lumbar spine, more serious sexual dysfunction may occur because the sympathetic nerves that control the penis originate here. When the second, third, fourth, and fifth sacral nerves or the conus medullaris are injured, not only can irreversible impotence occur, but also incontinence of urine and feces.

　　2. When spinal cord injury occurs due to spinal nerve damage, especially when the sacral nerve is damaged, permanent impotence may occur. Because severe damage to nerve tissue or the process of nerve degeneration is irreversible and permanent, the compressed nerve tissue often can recover its function. Within one week after the injury, if there is a recovery of certain movements or sensations, it indicates a good prognosis for future recovery. The nerve supply of the penis is dual, controlled by both sympathetic nerve fibers and parasympathetic nerves (S2-4). Any dysfunction that persists for 6 months without improvement is often permanent. Therefore, if a patient with spinal cord injury develops impotence and is unable to recover within half a year, it is considered permanent impotence, and drug treatment and other general treatments are not very effective.