Many theoretical and practical questions, connected with spine injuries, still remain unsolved, although significant success of medicine in treatment of bone injuries and particularly in treatment of uncomplicated spine fracture has achieved . Clinical syndromes of spine inferiority, leading a person to loose ability to work and make him/her as invalid, appear quite often in near or distant traumatic periods [2,3].
The purpose of this work was study and comparison of clinic and MRT research data of patients with trauma consequences of spine’s thoracolumbar division.
Material and methods of a research.
We have studied research and treatment results 49 patients with lower thoracic and lumbar vertebral body’s compressive fracture consequences, being at treatment in our Center and Andijan branch of RSCUMC(Republic Scientific Center of Urgent Medical Care) during the period of 2005 – 2009.
We have notices that, the biggest group included patients ranging at the age of 20 to 40 years - 67,1 % from total number treated patients. Mainly, traumas occurred in every day life, and work related traumas were noticed only in 9.8 % of patients.
Clinical signs of former injuries’ consequences appeared in the form of pain syndrome, functional failure of spine, spine instability, spine mobility limitation, rise of former available symptoms from content spinal canal and spine deformation side. These manifestations occurred either isolated or combined with different syndromes.
Determination of changes in intervertebral disk during posttraumatic period, presents doubtless interest. Recent usage of such method, like MRT, allowed more deep understanding of a character of spine’s pathologic changes in distant periods, particularly, role of hernia in intervertebral disk.
Results and discussion.
Paine seized whole damaged section of spinal column on 57,5 % of patients. In 37 % case it spread out on cephalic or caudal from the level of former damage. Pain was absent in calm condition and rose only in vertical position of suffered patient, frequently, it was connected with certain position or pose of patient in 41,6 % of patients. Constants local pains in other section of spine joined local pains in the place of former damage, quite often. Pain can arise or grow in cough, sneeze.
Functional failure of spine concluding in rapid fatigability and origin of fatigue feelings in former damage place, impossibility of keeping body in vertical position for long time was observed in 31,4 % of cases. Instability of spine was seen on that, patient could not be in a vertical position without external immobilization and frequently (in 27,8 % of cases) instability of spine combined with its functional failure. Both primary, and secondary spine deformation in non-observance of orthopedic preventive measures had a tendency of 24,5 % patients to progression.
We observed appearance of earlier absent medullispinal disorders on 37% of patients in insufficient treatment, or untimely-diagnosed damages in thoracolumbar section in the form of compressive wedge-shaped vertebral body fractures with minimal compression of spine ventral section.
Main MRT – signs of degenerative-dystrophic changes, observed in posttraumatic osteochondrosis of spine, are decreasing height and dehydration of intervertebral disks. Dehydration mostly observed in nucleus pulposus rather than in fibrous ring. The disk (and first of all nucleus pulposus) fibroses, cracks and amorphous cartilaginous mass arise in it. On Ò2-suspended image availability of cartilaginous fabric (with normal content of liquid) corresponds to high intension of signal, and availability of collagen and fibrous elements - low intensity. One of the earlier signs of disk degeneration is decreasing intensity of signal in central part of disk.
Invagination of external fiber of fibrous ring to the side of nucleus pulposus happen, replacement of central cartilage with fabrics rich in collagen, which, which leads to decrease of signal intension. These changes we have noticed in 91,4 % of patients. In the case of expressed changes in intervertebral disk, linear sections of high signal intension in Ò2-suspended image, reflecting availability of liquid in cracks of disk, sometimes emerged. These manifestations we observed on 11 patients.
More expressed pathologic changes in spine with big rear prolepses of degenerated disks in spinal canal lumen for 4-8 mm with different degree of dural bag compression and canal lumen coverage were detected in 27 patients from 37 with clinical picture of compressive radiculopathy in MRT.
Thus, besides certain correspondence between evidence of clinical symptomatic and MRT data, dissociation between them also met in number of cases (15 - 20 %).
On Ò1-suspended image disk hernia is seen, as displacement of disk substance beyond rear edge of locking plate of neighbor spine bodies. The signal intension disk hernia normally the same, as other parts of disk on 65,3 % of patients. Hernia’s intension signal decreases in expressed degeneration of disk, thus it is difficult to differentiate it from rear longitudinal ligament and liquor. In that case, effective Ò2-suspended image, when interrelation of hernia with rear longitudinal ligament determined well on sagittal shear, with hard brain tunic and epidural cavity. Subligamentosic hernia of disk is limited from the rear with striae low intension signal - rear longitudinal ligament, which remains intact. Hernia’s signal intension, in this mode, can vary (mainly it is less, rather than in liquor, but more in comparison to other parts of disk), while connection of hernia with disk itself remains, quite often. Sagittal Ò2-suspended image allows to reveal the extension of epidural veniplex about large hernia.
Sometimes in disk hernia, it is quite difficult to determine, whether integrity of rear longitudinal ligament is kept. In MRT external layer fibrous ring and rear longitudinal ligament join and constitute identical low signal intension as in T1 mode, as well as in T2 mode. Disconnection may be determined, if hypointensive striae of sagittal image, limint rear hernia edge, has break or lacks, also in the case of connection interposition (of hypointensive striae) between disk itself and its dropped fragment.
The important moment for correct interpretation of magnetic-resonance tomography is evaluation of axial (cross) cut, as long as it is possible to determine hernia’s situation type (median, paramedian or posterolateral) according to them, determines its dimensions, cover area of spinal canal lumen and degree of compressing dural bag.
We have been introduced, that undertaking MRT, on patients who have consequences of vertebral fracture in thoracolumbar division, is required in following cases: if expressed radiculopathy gives in treatment badly during 1 month; when there is moving defect; when the reason of radiculopathy is not clear.
- Hernia drop outs of intervertebral disks, caused by traumatic damage of themselves, are rarely diagnosed with the usage of different rentgenologic methods, undertaking MRT researches are preferred. Changes, observed during this process, rarely differ from changes in degenerative-dystrophic processes.
- Results of MRT allow to determine to choose adequate treatment methods to patients with consequences of compressive fractures of vertebral body of thoracolumbar division from Pathogenetic point of view.
- Afuanov A.I., Korjik A.d. Medical tactics in uncomplicated spinal damages. // Problems of spinal surgery and spinal cord. Theses of All-Russian scientific-practical conference, Novosibirsk, 1996.- P.26-29.
- Denis F. Spinal stability as defined by the three-column spine concept in acute spinal trauma. - Clin. Orthop., 1984., 189:65.
- Holdsworth F.W. Fractures, dislocations, and fracture - dislocations of the spine. - J.Bone Joint Surg., 1998, 52A: 1534-39.