Complete cervical spinal cord injury

Introduction Cervical spinal cord injury refers to cervical spinal cord injury caused by cervical spine fractures, which manifests as different degrees of paralysis and dysfunction of the limbs and trunk. Patients often have difficulty in breathing due to respiratory muscle spasm, chest tightness, etc., and because of orthostatic hypotension are prone to dizziness, vertigo, and palpitation. Cervical spinal cord injury is divided into complete injury and incomplete injury according to the degree of injury. Complete injury is that there is no sensation when the pointer stabs the anus, and there is no voluntary contraction of the external anal sphincter during anal examination. Incomplete injury is the feeling when the pointer stabs the anus, or the anal external sphincter has an arbitrary contraction when the anus is diagnosed. Usually, the sensory function and motor function of the limbs after cervical spinal cord injury will be restored to varying degrees.

Cause

The common cause of cervical spinal cord injury is a car accident, followed by heavy body bruises. Acute complete cervical spinal cord injury is mostly sudden injury in labor, leading to cervical spine fracture, dislocation or shackle, and even high paraplegia.

an examination

Related inspection

Periosteal reflex Hoffman sign

Clinically, it is usually possible to judge the cervical spinal cord injury segment by X-ray showing the site of cervical spine fracture and dislocation, but sometimes the cervical vertebrae change is not obvious, so it is necessary to carefully check the skin sensory disturbance, muscle movement disorder and reflection changes. . In the relationship between anatomy and function, many nerve distributions are crossed or overlapped and must be carefully identified during the examination. Sometimes it is even necessary to go through repeated inspections or to determine the plane of the sensory obstacle from different directions to obtain a more accurate conclusion. The neck 3-4 is matched to the entire upper neck and is expressed as a shawl-like upper chest. The extent of the lower neck injury is determined by examining the sensory distribution of the upper limbs. The upper cervical spinal cord injury (neck 1-2) was more critical, and the limbs showed sputum paralysis after the shock period. Due to paralysis of the respiratory muscles, it can be fatal quickly. If there is a manifestation of visceral dysfunction such as arrhythmia and unstable blood pressure, it often indicates medullary involvement. The middle cervical spinal cord injury (neck 5-7) is the neck enlargement, which is characterized by quadriplegia. If the neck 5 is heavier, the diaphragm is obviously paralyzed, the biceps muscle, the deltoid muscle reflex is weakened or disappeared, and the feeling below the neck is lost. If the neck 6 is dominant, the deltoid muscle function changes are not obvious. Most of the injured upper limbs in this department are delayed sputum. The lower cervical spinal cord (neck 8 and chest 1) is mainly caused by the lower limb paralysis, and the upper limb is mainly characterized by the internal muscle changes of the hand. Such as the interosseous muscle, the squamous muscle atrophy, forming a claw-shaped hand.

Differential diagnosis

Differential diagnosis of complete cervical spinal cord injury:

Spinal cord injury: can be divided into primary spinal cord injury and secondary spinal cord injury. The former refers to the damage caused by external forces acting directly or indirectly on the spinal cord. The latter refers to the spinal cord edema caused by external force, hemorrhage caused by small blood vessel hemorrhage in the spinal canal, compression fracture and broken disc tissue to form further damage to the spinal cord caused by spinal cord compression. Experimental studies have shown that primary spinal cord injury is often local and incomplete, and after the injury, there are a large number of local release and accumulation of catecholamine neurotransmitters such as norepinephrine, dopamine, etc., causing local microvascular vasospasm, Ischemia, increased vascular permeability, rupture of venules, and secondary hemorrhagic necrosis. The self-destructive phenomenon of massive hemorrhagic necrosis in the central part of the spinal cord after spinal cord injury is referred to as hemorrhagic necrosis, which is an important pathological process secondary to spinal cord injury.

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