What are the protruding spinous processes of the spine. Signs and treatment of spinal processes in case of a fracture How long do fractures of the vertebral processes grow together

7574 0

When examining the tops of the spinous processes, attention should be paid to the degree of protrusion of each of them. A sharp protrusion of the process is called a "point rib", it is associated with the disposition of the vertebra as a result of displacement back or deformation during its destruction (Fig. 130). The occlusion of one of the spinous processes, in comparison with the adjacent ones, is associated with anterior displacement of the vertebra or a fracture of the spinous process. We must remember one physiological feature: the spinous process of the II lumbar vertebra can protrude posteriorly more than the neighboring ones.

Rice. 130. Tuberculous spondylitis. The focus of destruction in the vertebrae (1) led to spinal deformity and the formation of a "point hump", as indicated by the protruding spinous process (2)

When examining the spinous processes, attention is drawn to the size of the gaps between them. Normally, in different parts of the spine, it is different. It is important to identify the difference between adjacent processes. This is always considered as a deviation from the norm and requires clarification, possible causes are displacement or destruction of the vertebra, fracture of the spinous process, rupture of the ligaments between the processes.

West and soreness of the interspinous spaces indicate sprains or rupture of the supra- and interspinous ligaments (Fig. 131). More often it is noted between the V lumbar and I sacral vertebrae (Bostrup's disease). This happens in young people after lifting weights in front of them, falling on the buttocks with straightened legs, when falling down stairs and is referred to as "springy" back syndrome. Sometimes localized pain in this syndrome may not be accompanied by pressure on the interspinous spaces, it is constant, harassing the patient. Often it radiates to the buttocks, at rest it can subside, and recur with physical exertion.

Rice. 131. Palpation of supra- and interspinous ligaments. The index or middle finger of the right hand, better in a half-bent state, plunges into the interspinous spaces with sufficient force. The arm can be placed perpendicular or better along the spine (A). Pain that occurs indicates damage to the ligaments or disc. If a rupture of the interspinous ligaments is suspected, the study is carried out with pillows under the patient's stomach (b). This position expands the interspinous space and favors the detection of its sharp expansion and the appearance of depressions between adjacent spinous processes when the ligaments are torn.

During palpation examination of the spinous processes in the vertical position of the patient, the resulting hyperemia of the skin above them can serve as a good guide for detecting curvature of the spine to the side - scoliosis.

A more objective way to detect scoliosis is to focus on the plumb line (lowered from the occiput to the intergluteal crease) and the spinous processes of the vertebrae. Their coincidence excludes scoliosis, non-coincidence - confirms (Fig. 132).

Rice. 132. Right-sided scoliosis of the thoracic spine. The spine (spinous processes) in the thoracic region deviates to the right from a plumb line passing through the occipital
tubercle and intergluteal fold

Scoliosis of the thoracic region can be independent or compensatory for scoliosis of the lumbar region, in the latter case, the curvature will be multidirectional.

If scoliosis of the thoracic region is suspected, a test is used with the torso tilted forward until the fingers touch the floor or feet. In this position, in the presence of true scoliosis, a clear asymmetry of the chest is revealed, resulting from the rotation of the vertebrae with a change in the position of the ribs. Scoliosis, caused by negligence in posture, disappears when the torso is tilted.

Scoliosis of the lumbar spine is also easy to identify using a plumb line. Its cause is often sciatica and sciatica (Fig. 133). Curvature of the spine to the diseased side is observed with damage to the sciatic nerve, curved to the healthy side - with sciatica, which reduces the compression of the roots on the diseased side. Scoliosis occurs as a protective reflex reaction, accompanied by tension in the lumbar and long back muscles.

Rice. 133. Scoliosis in lumbosacral sciatica ("anti-pain", protective-reflex)

Soreness of the spine can be detected by pressing the thumb or third finger of the right hand on the spinous processes, going from top to bottom from vertebra to vertebra, or by tapping with the terminal phalanx of the third finger, as in normal percussion. With pressure or percussion III finger II and IV fingers of the same hand are installed on the sides of the spinous processes. This is necessary to perceive the tension of the back muscles in the area of ​​pain. You can use the hammer of a neurologist or the outer fleshy surface of the fist to tap on the spinous processes.

Local pain with pressure or tapping along the spinous processes of the vertebrae occurs with an "unstable" vertebra, protrusion (protrusion) of the intervertebral disc, with fractures and destruction of the vertebral body (inflammation, swelling) (Fig. 134, 135).

Rice. 134. Identification of pain by percussion along the spinous processes. There are several research options. 1. As shown in the figure, the usual percussion is performed with the III finger of the right hand. The finger can be replaced with a neurological hammer. 2. The doctor's left hand is placed along the spine so that II and III fingers lie on the sides of the studied spinous process with slight compression on the muscles to perceive reflex muscle tension when hitting the spinous process of the pathologically altered vertebra. Blows are applied with the middle finger of the right hand or with a neurological hammer

Rice. 135. Identification of local pain by pressing on the spinous processes. For greater effort, the thumb of the right hand is used, all the spinous processes are sequentially examined, and especially in the area of ​​pain, visible deformity of the spine and displacement of the spinous processes. In these areas, compression with a finger begins with a slight effort, it should not be strong, it stops with the appearance of pain.

The arcuate and costovertebral joints are not palpable, however, deep palpation with thumb pressure along the paravertebral lines 1.5-2 cm away from the line of spinous processes in the thoracic and 2-3 cm in the lumbar can reveal a zone of pain (Fig. 136 ).

Rice. 136. Palpation of the articular processes of the spine. The doctor's thumbs are strongly immersed in the tissues near the spinous processes (1.5-2 cm from the spinous processes in the thoracic region and 2-5 cm in the lumbar region). Soreness occurs with inflammatory lesions of the joints, ligament damage, disc pathology, fractures of the transverse processes

I.A. Reutsky, V.F. Marinin, A.V. Glotov

Fracture of the transverse process is one of the most common spinal injuries. Usually affects men aged 20-40 years, engaged in heavy physical labor. This type of fracture is also known as a "digger's injury" and occurs in two variants:

• direct - the blow falls directly on the fracture area;
• indirect - the process breaks due to the fact that the muscles attached to it contract too much.

Most often, a fracture of the vertebral process occurs in the lumbar region. Along with isolated fractures, there are also multiple fractures. Often the processes of one vertebra, located on different sides of the central axis, suffer.

Fractures of the processes can occur with displacement. In this case, the injury spreads to nearby tissues: muscles, nerve roots, blood vessels, hematoma and edema are formed.

Symptoms of a spinal fracture

• Acute pain syndrome, which becomes stronger when bending over. Payr's symptom is expressed: the most painful are the inclinations in the direction opposite to the damaged vertebra.
• Difficulty lifting the leg on the side of the injured process from a prone position. Movement causes increased pain and is often simply impossible. This symptom of a fracture is commonly referred to as the “stuck heel symptom”.
• Increased pain during movements in the hip joint, located on the affected side of the body.
• If there is a displaced fracture and a nerve root is injured, there may be hyperesthesia or hypoesthesia (increased or decreased sensitivity, respectively), as well as problems with urination.
• Swelling at the site of injury.

Treatment

A spinal fracture is usually treated conservatively. Full bed rest is shown for 3-4 weeks. In this case, the position of the patient in bed is very important.

You should lie down in the so-called "frog pose". To take this position, lie on your back, bend your legs at the knees and at the hip joints. They are slightly bred to the sides, and a roller is placed under the knees.

Since fractures of the processes are always accompanied by severe pain, either novocaine blockade according to Vishnevsky or Kaplan is used. Local anesthetics are also used.

From physiotherapy in the acute period, ultrasound treatment is indicated, which helps to reduce the severity of the pain syndrome.

Rehabilitation measures after this spinal injury include massage procedures, spa treatment and special therapeutic exercises (exercise therapy).

In the presence of prompt medical care, the prognosis for injuries of the transverse processes is usually favorable. The victim fully recovers after two months.

A spinal fracture is a trauma that doctors encounter quite often. Typically, such damage is localized in groups of males aged 20 to 40 years. Hard physical labor can precede this: the pressure regularly exerted on the bone zone makes the bones of the skeleton vulnerable and brittle.

There are two types of injury: direct and indirect. Direct injury is preceded by a strong blow aimed directly at the area of ​​injury. An indirect fracture of the process can occur in case of excessive contraction of the muscle tissue that is attached to the bone area.

The most common localization of injury is the lumbar region. This injury is also called a digger fracture. Most often, the injury is isolated, that is, it is present in only one area of ​​\u200b\u200bthe bone. More serious damage extends to several bone processes at once. There are also cases of localization of damage in several processes of the vertebra at once, located parallel to each other.

Particularly complex injuries are those in which there is bone displacement. Such a pathology can cause a number of complications, which include bleeding due to damage to muscles, arteries or capillaries. A symptom of injury may be swelling and hematoma formation in the damaged area.

How to determine

Upon receipt of damage, it is necessary to immediately determine its nature, it is often characterized by certain symptoms:

Pain	Pain localized in the damaged area becomes especially noticeable when the body is tilted forward or backward. Leaning in the direction opposite to the bone area in which there is damage, a person can feel a stabbing and extremely sharp pain. This symptom is called Payr's symptom.
Movement disorder	In the event of a break off of the process, the patient cannot raise the lower limbs while lying on his back. When you try to lift your leg, the pain begins to intensify. Movements in the hip joint are also difficult
Hyper- or hypoesthesia	When the nerve root is injured, which can occur as a result of a fracture with displacement, sensitivity increases or, conversely, disappears in the damaged area
puffiness	In the localization of the injury, there is an edema of impressive size

Consequences of trauma

In the absence of timely treatment, the consequences of damage can be extremely serious. So, one of the most striking examples of complications is the development of scoliosis. The disease is a change in the shape of the spine, its wrong bend.

In especially severe cases, the presence of scoliosis can lead to impaired motor activity and even disability of the patient. That is why, the consequences and treatment of trauma are closely related concepts. Proper healing can quickly put the patient on his feet. The main thing is to seek help in time and follow all the recommendations of the attending physician.

Damage treatment

The most commonly used method is the conservative treatment of fractures of the vertebral processes. After diagnosing an injury by the attending physician, the patient is prescribed permanent bed rest, which is contraindicated to violate. This technique should be practiced for a month.

An important point in observing bed rest is the correct position of the body. In order for the tissue to grow together normally, the patient must regularly take the frog pose, that is, lie with knees bent and legs spread apart. Soft cushions are placed under the knees for convenience.

An obligatory moment during the rehabilitation period is the use of analgesics to reduce pain, as well as anti-inflammatory drugs. Rehabilitation at an early stage of treatment involves the use of physiotherapy technologies, namely, ultrasound, which relieves pain.

The spine is characterized by a complex structure and is the main structural element of the axial skeleton. In addition to maintaining the body in an upright position, it provides protection for the spinal cord, and is also the site of attachment of various structures of the musculoskeletal system.

Due to the presence of physiological curves, the spine absorbs shocks and shocks while walking, running, jumping, thereby protecting the brain from concussions and reducing the load on the vertebrae. The protruding spinous processes limit the range of motion of the spine in the anteroposterior direction, while maintaining its integrity.

The structure of the vertebrae

The spinal column is divided into 5 sections, which are formed by 32-34 small bones, sequentially located one above the other. The vertebrae are interconnected by means of joints, cartilage and ligaments. Regardless of the area of ​​placement, all vertebrae are similar in structure. In their structure, there are:

• body;
• arc;
• 7 branches.

The vertebral bodies are formed by a spongy substance, they look like a flattened cylinder. Connecting to each other through the intervertebral discs, form the spinal column. Their dimensions differ depending on the axial load exerted on them.

Important: Due to the low mechanical strength of the vertebral bodies, the neck section is the most vulnerable to various injuries.

An arc is attached to the body from behind with two legs, forming a vertebral opening for the location of the spinal cord. On the arc are the processes of the spine, providing the trunk, neck and head with a significant amplitude of rotational and flexion movements.

Features of the structure of the processes of the vertebrae

Each vertebra has 7 processes. On the sides of the arch there is a pair of transverse spines connected by transverse ligaments. Above and below the arc are 2 pairs of articular processes. Through these protrusions, the vertebrae are attached to each other, forming facet joints.

Single processes extending back from the vertebrae, interconnected by interspinous ligaments, are called spinous. In addition to ligaments, muscles are attached to the transverse and spinous processes.

The spinous processes are easy to feel along the line of the spine. The longest is the spinous process of the 7th cervical vertebra. Focusing on this spine, you can count other vertebrae.

Examination of the spine by spinous processes

The spinous processes of the spine with a normal structure should form a strictly vertical line. Changes in the structure of the spinal column can be determined by palpation of the back. There are 2 ways to check the location of the spinous processes:

In the first case, the apex of the protruding spines is felt with the index finger of the right hand. Inspection starts from the IV-V cervical vertebra, moving the index finger down to the sacrum.

Important: The longest and most protruding spinous process of the 7th cervical vertebra is easily palpable. Having determined its position, it is possible to accurately count all other vertebrae.

When feeling the spine using the Turner method, the palmar edge of the hand is applied to the surface of the back at an angle of 45 °. With the movement of the palm in the direction of the spinal column, the spinous processes of the vertebrae are felt, taking into account the distances between them. To detect pain, palpation is performed with compression with the middle and thumb, and then percussed with the middle finger.

When examining a healthy spine, palpation and tapping are not accompanied by painful sensations. If there is pain or tension in the muscles adjacent to the protruding awns, this may indicate the presence of pathology.

When identifying diseases of the spine, you should immediately consult a doctor. A qualified specialist will determine a list of additional studies and, in accordance with the results obtained, recommend an effective treatment.

Fractures of the spinous processes of the cervical spine are a serious injury that, if not properly treated, can lead to serious problems.

Negligence in relation to the neck and its components is unforgivable, since the cervical vertebrae are located in close proximity to the human brain and the slightest violation can hurt it.

Features of the structure of the vertebrae

The spinous processes are small, with a forked end. They serve to control the mobility of the cervical vertebrae, act as some limiters when the head is tilted to the sides. The cervical region is larger than the thoracic and lumbar spine, subject to mechanical damage due to weak neck muscles, small vertebrae. More dangerous than others are injuries to the first cervical vertebra, the so-called atlas, and the second, the axis, since the atlantoaxial-occipital complex formed by them serves to connect the head to the back. Most often, the deformation occurs with the fourth, fifth and sixth cervical vertebrae.

Causes of damage

Among the main causes of fracture of the spinous processes of the cervical vertebrae, the following should be noted:

• direct blows to the neck with a heavy object.
• A sharp throwing of the head back due to an accident or external influence.
• Sports injuries.
• Blockages in mines also often cause fractures, since the cervical vertebrae are not designed for heavy weight.

Types of injury

In addition to damage to the spinous processes of the spine, deformity of the transverse process also often occurs. The transverse processes serve to accompany the arteries and veins to the brain, so their damage is an order of magnitude more dangerous. Violation of the integrity of the processes of the spine can also lead to spinal cord injuries, although not as often as with other back injuries. However, practice shows that isolated fractures and dislocations of the spinal column in the processes are extremely rare, and usually occur together with other injuries, so one should not neglect such violations of the integrity of the bone tissue.

Clinical picture

Pain at the site of injury to the neck will serve as the most accurate symptom of a fracture of the processes of the spine. Immediately after the fracture, swelling of the soft tissues begins, the groove of the spine in this area is smoothed out.

When palpation of the injury site, you can feel the fragments of bones under your fingers, but you should not do it just like that, because a person without special medical education can only aggravate an already dangerous situation by such actions.

The impossibility of any movements of the back, in particular the neck, also indicates a fracture-dislocation of the spinal column. In no case should you try to turn your head or lean forward / backward through force - such actions only increase damage to the vertebrae, as well as the pain effect.

The tension of the cervical muscles, in which the victim is forced to keep his head in only one position, also serves as a symptom of injury, however, in such a situation, dislocation of the cervical vertebrae also most often occurs, so first aid should be provided with utmost care.

Numbness of the hands, impaired hearing and vision of the patient is a sign of cerebrovascular accident, which may occur due to deformation of the processes. In such situations, fragments of bones or displacement of the vertebrae compress the veins and arteries, which causes interruptions in blood supply.

Diagnostics

The symptoms described above do not yet give full confidence in the fracture of the spinous process, so it is necessary to undergo a diagnosis from specialists. First of all, with such complaints, the patient is sent for x-rays in frontal and lateral projections. With a properly performed x-ray, all cervical vertebrae are visible, so it will not be difficult to notice a fracture of the spinous process of the spine. Using x-rays, specialists can also distinguish between compression and non-compression fractures of the spine.

Examination using computed tomography will give an even more accurate picture of the disease, since its data show information about damage inaccessible to x-rays, the state of nearby tissues, and the location of fragments of broken bones.

Video

Compression vertebrae

Treatment Methods

Therapy of a fracture of the transverse and spinous processes occurs only in a hospital under the supervision of a doctor. The entire period of treatment takes place with mandatory bed rest, so as not to strain the damaged areas of the neck once again.

Conservative treatment

Conservative treatment of fractures is used when you can do without surgery. The following methods are involved here:

Surgery

The operation is prescribed for serious fractures of the transverse process of the spine, when surgical intervention is necessary, and conservative methods are ineffective. Then the specialists remove the bone fragment of the vertebra so that it does not damage the nerves and blood vessels surrounding the spinal column.

First aid

The injured person should be placed on their back on a hard, hard surface, but this should not be rushed. Transfer should be done without sudden movements to avoid increased damage. Use improvised methods to create something like a collar, with its help to fix the neck and head of the victim in order to avoid displacement of bone fragments or fracture and dislocation of the arches on which the spinous processes are attached.

In this condition, either wait for the ambulance doctors, or independently deliver to the nearest medical facility.

Rehabilitation

The course of rehabilitation is in many ways similar to the usual methods after the treatment of fractures. From the first days, physical therapy, swimming, massage, various physiotherapy procedures (UHF, magnetotherapy, electrophoresis) begin. At the same time, the patient is observed by doctors, and wearing a Shants collar or a pharmacy corset is mandatory, since they reduce the load on the vertebrae, reduce the range of motion in the spine and head. The treatment ends with a second X-ray, the results of which either confirm the successful repair of the fracture in the cervical region, or indicate the need for additional curation.

For rehabilitation, folk methods are also used that help the patient recover after a course of therapy. Among them are:

1. Rosehip decoction nourishes the body with vitamins that speed up the healing process. It is quite easy to prepare it, for this you need to take 2 tablespoons of rose hips, pour 400 milliliters of boiling water. Cook on low heat for 15 minutes, and after cooling, drink separately from the berries three times a day, 15 minutes before meals. Continue for two weeks.
2. You can restore the cartilage layer, strengthen bone tissue with the help of a nut mixture. For this, cashew nuts, walnuts, hazelnuts are taken. In a 1:1 ratio, crushed nuts are mixed with honey. This mixture is stored for no more than a day, and should be taken one teaspoon three times a day 30 minutes before meals for 10 days.
3. A mixture of sea buckthorn and blackcurrant will help to saturate the body with vitamin C, strengthen bones. The recipe is as follows: 1 teaspoon of sea buckthorn, 1 tablespoon of blackcurrant are crushed in a blender with added sugar for taste. Take it half an hour before meals, 1 teaspoon twice a day for a week.

Complications

Among the most common and dangerous consequences of trauma to the transverse or spinous process of the spine, experts note such as complete paralysis of the patient, impaired respiratory function, and acute heart failure. There are also situations when, in violation of the integrity of the transverse process, the spinal cord was torn, and damage to the atlas led to hemorrhages in the brain.

Due to prolonged lying down, bedsores may appear, which can be relieved by massage or small physical exertion and simple exercises.

Forecast

With timely and high-quality treatment, complications should not arise, and the consequences of the injury dissipate throughout the year, cease to disturb the survivor of the deformation. However, if the injury was with complications, then there may be some consequences associated with loss of coordination, dizziness, aching pain in the back and neck.

Correct preventive measures, namely, fastening a seat belt when driving a car; checking swimming spots, diving for shallows and pitfalls to avoid hitting the head and neck; do not turn, do not throw back your head sharply, as this in itself can lead to complications.