Flexor paraplegia

Introduction

Introduction

Paraplegia refers to the occurrence of transverse lesions at the level of the spinal cord. Complete spinal cord injury is a flexion paraplegia, and partial lesions exhibit an extensor paraplegia. Sometimes stimulating the lower extremities can cause irreversible buckling and platooning overall reflexes. Spinal cord injury usually occurs at the junction of a more active spinal segment and a less active segment. The neck and thoracolumbar junctions (thorax 11 to waist 2) are the most frequently affected areas of spinal cord injury, followed by the incidence of thoracic or lumbar regions.

Pathogen

Cause

Causes

The cause of closed spinal cord injury is that violence acts indirectly or directly on the spine and causes fracture and/or dislocation, causing spinal cord, ponytail compression, and injury. About 10% of patients with spinal cord injury have no obvious imaging changes of fracture and dislocation. They are called spinal cord injury without radiographic abnormalities. They are more common in children with strong spinal column elasticity and the elderly with original spinal stenosis or hyperosteogeny.

Direct violence is relatively rare, seen in heavy objects hitting the back of the neck, back, waist, corresponding parts of the lamina, spinous process fractures, fracture pieces into the spinal canal.

Indirect violence accounts for the vast majority of injuries, which are common in traffic accidents, falling from heights, collapse of buildings, collapse of tunnels, and sports. Violence acts on other parts of the body and is transmitted to the spine beyond normal limits of flexion, extension, rotation, lateral flexion, vertical compression, or traction (mostly mixed motion), resulting in damage and fracture of the ligament that maintains spinal stability. , vertebral fractures and/or dislocations, facet joint fractures and/or dislocations, accessory fractures, disc herniation, ligamentum flavum wrinkles, etc., cause spinal cord compression and injury.

Examine

an examination

Related inspection

Bone marrow image analysis random motion check

X-ray film

Normal position, lateral position, and double oblique position should be taken, but should be prevented from over-moving the patient for good imaging results. It is advisable to take a lateral slice first. You should observe when reading the film:

1 The overall alignment of the spine, alignment;

2 types of vertebral fractures and dislocations;

3 attachments have no fractures;

4 Whether there is stenosis or widening of the intervertebral space (revelation of disc herniation and anterior longitudinal ligament rupture, respectively), and whether there is a widening of the spinous process gap (indicating the injury of the interspinous ligament). The first two of them are the most significant, but sometimes the injury is severely dislocated, and the line can be restored afterwards. Excessive flexion can observe stability, but should be used with caution.

2. CT scan

Axial CT can show the shape of the spinal canal and the presence or absence of fracture. After the lumbar puncture is injected with water-soluble contrast agent and then CT, the prominent disc and spinal cord compression displacement can be clearly displayed. When the spinal cord edema is thickened, the annular subarachnoid space can be narrowed or disappeared.

3. Spinal cord iodine angiography

It can show the presence or absence of obstruction in the subarachnoid space, the degree and direction of spinal cord compression, and the involvement of nerve roots.

Diagnosis

Differential diagnosis

Differential diagnosis

Spinal horseshoe involvement: spinal cord, cauda equina or nerve root involvement is one of the symptoms of spinal cord injury. The number of patients with spinal injuries is increasing, depending on the mechanism of damage, and the classification is also different, so it is also difficult to diagnose. However, in fact, as long as the local pathological anatomical features can be grasped, comprehensive diagnosis and judgment can be made under the premise of comprehensive collection of traumatic history, symptoms and signs, and it is not difficult to obtain a correct diagnosis for most cases. On this basis, the treatment problem is also easy to solve. For some patients with clinical difficulties, CT, MRI, CT plus myelography, CTM and other imaging methods can be used.

Spinal cord compression: fracture displacement, broken bone fragments and broken discs can be directly compressed into the spinal canal, and the pleated yellow ligament and rapidly forming hematoma can also compress the spinal cord, causing a series of pathological changes of spinal cord injury. .

Spinal cord compression: Spinal cord compression refers to a group of conditions in which the spinal cord, spinal nerve roots, and their supply vessels are compressed by lesions of various natures.

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