In this case, we can draw an analogy of a bicycle chain, which consists of interconnected units. Accordingly, the spine of interconnected spinal motion segments. Vertebral-motor segment work properly only when forming the normal function of the segment structure. If damaged structures form motor segment can "solve" his segment with the formation of hypermobility. This condition is called instability, and is the cause of chronic pain, rapid degenerative changes in the affected segment, as well as damage to the nervous structures.
Kyphotic spinal deformityUsually there is a bend in the kyphotic thoracic spine. However, if the kyphotic bend 40-45 degrees such a deformation of the spine is considered pathological. In a patient with spinal kyphosis were a "hump". Kyphosis of the spine most often seen in older women with osteoporosis, which often develops compression fractures of the vertebrae. The front part of the vertebral body kollabiruetsya whereby deformation of the vertebral body wedge. Changing the configuration of the spinal column can lead to an overload of certain spinal motion segments, and development of muscle spasms, which contributes to chronic pain.
Neurological complications
If the fragments of the damaged vertebral body leading to the spinal cord or nerve roots compression, it may develop neurological complications. Normally between the spinal cord and the wall of the spinal canal, there is a small room. However, at the turn of the spinal canal of the vertebral body by them in the fragments of the vertebral body are narrowed. For some people there is an inherent narrowness of the spinal canal and in these cases, a small projection of bone fragments in the channel can lead to a compression of the spinal cord. At the turn of the spine in some cases, damage to the nervous structures take immediately at the time of the injury, such as gradually in other, sometimes develops a few weeks or even months after the injury. Caused in these "delayed" cases of damage caused by neural structures, as a rule, not the actual trauma and vascular disorders of the spinal cord by the compression of the blood vessels that nourish the nervous structures. Circulatory disorders caused by a narrowing of the spinal canal by bending the bone fragments. This condition is called spinal stenosis. In this case, to reduce the symptoms of pain, numbness of the body, the muscle strength in the legs, bowel and bladder disorders is gradually increasing, and are symptomatic of serious damage to the spinal cord, called myelopathy. In these cases, only the operation stop of irreversible damage to neurons in the spinal cord.
Treatment
Conservative treatmentThe treatment of compression fractures of the spine, in most cases includes, analgesics, the compliance of the conservative treatment and the use of special and reklinators corset belt. In some cases, and surgical treatment.
Analgesics, the severity of pain. However, remember that pain medications do not contribute to the healing of the fracture. A significant improvement in health is the cessation of pain after the onset of pain is not that the disease is cured. Breaking fused optimum time is necessary in order to observe protective regime. During fracture consolidation (12-14 weeks) to avoid physical stress, which lead to an increase in the degree of deformation in the fractured vertebral body. Categorically denied to lift weights, large tilt and twist your body. In many cases, in a few weeks, your doctor may recommend bed rest compliance. This is especially important for elderly patients with osteoporosis, fracture healing is not as easy and fast as younger people.
Most patients require special corset to create. This means external fixation minimizes movement in the affected vertebral segment which contributes to the strengthening of the fracture. Miedergürtel used for fractures, solid spine in hyperextension (hyperextension). Thereby reducing the pressure on the front side of the damaged vertebral body, reduce its kollabirovanie.
Compression fractures of the vertebrae fused in most cases within three months. Typically, the spine x-rays every month to monitor the process of consolidating fractured vertebra.
Surgical treatment
The surgical treatment of compression fractures of the spine due to compression of neural structures (spinal cord, nerve roots), spinal instability and shown by pain. For example, the height of the vertebral body on radiographs reduced available by more than 50% is the instability of the spine, which may be (relative to the movement) to perform dynamic compression of neural structures. In this case, the operation is necessary to prevent a damage to the spinal cord and nerve roots.
There are several types of operations to be performed during the compression fractures of the spine. Depending on the nature of the fracture, can choose the severity of compression of nerve structures doctor,. One or other type of operation The basic principles of surgery for fractures of the spine is to decompress the neural structures (if there is evidence of compression of the bone structure of the spinal cord or nerve roots) damaged and stabilization (fixation in a physiologically advantageous position) vertebral segment.
Anterior approach
Upon squeezing the front of the spinal cord destroyed vertebral surgeon performs the operation. Usually from the anterior approach This incision is made on the anterolateral surface of the chest or abdomen. Further excavation of the damaged vertebra. Remotely bone fragments, compressing the bone marrow. Performed after the decompression is to stabilize the spine. To do this, rather than remote vertebrae damaged founded bone graft. Currently, grafts are used, from the patient's own bone (auotransplantanty), and specially treated cadaver bone (allograft). Gaining wide popularity for the stabilization of the spine cages - artificial disc replacement or spinal. Cages made of titanium or durable plastic. Cage filled bone fragments that special knife from the crest of the pelvic bone removed. After a few months, the fusion of the graft to the bodies above and the underlying vertebra in a conglomerate. For fixation of the graft and the damaged vertebral segment in a physiologically correct position with special stabilizing system, which may consist of screws, plates, lintels and beams. A strong, inert materials that do not cause rejection by the body - Details stabilizer systems are made of titanium or titanium carbide.
Back
In many cases, the stabilization of the spine through an incision in the back are performed (posterior). Posterior access operation performed in the majority of cases in the absence of significant compression of the spine anterior fragments of the destroyed vertebral body. Osteosynthesis of the damaged vertebral segment in the correct position with special stabilization system prevents damage to the nerve structures to early mobilization of patients for optimal fusion of bone structures. The most frequently in the recent years transpedicular spinal stabilization used. In this technique, the coil are performed by legs vertebrae vertebrae. Screws on each side are stable beams that connect the vertebrae in a single conglomerate connected. These stabilizing systems are highly reliable, which allows the activation of the patients in the first days after surgery.
No comments:
Post a Comment