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What are the protruding spinous processes of the spine. Symptoms of a fracture of the spinous process of the cervical vertebra and first aid Fracture of the transverse processes of the lumbar vertebrae

It is the basis of the entire human musculoskeletal system. Improper distribution of the load or heavy physical labor adversely affects it, thereby undermining the general condition of the body.

One of the most common spinal injuries is a fracture of the transverse process. It is also called "digger's injury" because of the characteristic features of the fracture. At risk are men 20-40 years old engaged in heavy physical labor.

Between the arches of the vertebrae is the spinal canal, formed from the vertebral foramina. It is in this canal that the spinal cord is located. Such a vulnerable location of the spinal cord can lead to damage to the processes of the vertebra.

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The fracture itself occurs as a result of a sharp contraction of the square psoas muscle.

Reasons for development

Fracture of the spinous process of the spine

Since the square muscle is associated with several rows of processes, any sharp contraction of this muscle leads to their damage.

Fracture of the processes of the spine can occur when lifting weights. In addition, sports, impacts, accidents and direct impacts on the spine can cause a fracture of the transverse process of the vertebra.

Due to the advanced forms of some diseases, such as osteoporosis, you can also get such an injury.

Older people are predisposed to this problem, but many simply do not pay due attention to the symptoms. Meanwhile, almost 40% of women received such a fracture at least once in their lives.

Symptoms

Transverse process injuries are of three types:

  1. Comminuted fractures.
  2. With displacement of the process.
  3. Right or left handed.

Fracture of the spinous process of the cervical vertebra most often occurs with displacement of fragments. Complicating the situation is the fact that there may be several fractures. Symptoms of a fracture of the transverse process of the spine are similar to the previous type of injury, and can also turn into a more serious disease.

Fracture of the transverse process of the spine is the most common type of injury. With it, there is no rupture of the ligaments, but several vertebrae are damaged at once. The so-called compression fracture affects the vessels, tissues and nerves.

If the injury was preceded by an unstable stretching of the vertebrae, then a decompression fracture appears. It can be open or closed. In the first case, the injury is most dangerous.

The signs of a fracture of the transverse process of the spine and a fracture of the spinous processes are slightly different from each other, but the following general symptoms can be distinguished:

  1. Strong pain.
  2. Increased pain during movement.
  3. Lifting or bending the leg causes sharp pain.
  4. Difficulty lifting the back off the floor.

Depending on the type of damage, other unpleasant sensations may also appear. A hematoma may appear at the site of the injury, and due to damage to the nerve fibers, pressure decreases and urination becomes difficult.

Diagnostics

Fractures of the processes of the spine

Of course X-ray will be the most proven and budgetary diagnostic method.. A vertebral injury looks like a curved line on the x-ray. But the X-ray is much inferior to its more modern relatives. Due to the overlay of intestinal gas shadows, inaccuracies and errors in the diagnosis may occur, therefore, if possible, it is better to resort to other instrumental diagnostic studies.

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These include computed and nuclear resonance imaging. All checks should take place under the strict guidance of neurologists.

Methods of treatment

There are several ways to treat a fracture of the processes of the spine: drug therapy, folk remedies and surgery.

It is better to entrust the treatment of a vertebral process fracture to competent doctors. But competently provided first aid can greatly affect the outcome of all medical therapy.

If you have witnessed such an injury, The first step is to ensure that there is no movement. Then, since this is all accompanied by severe pain, resort to painkillers and fix the back. The cervical region must also be immobilized, any turn of the head leads to pain.

Medical therapy

Treatment for fractures of the spinous processes of the spine includes complex medical therapy. For a more correct prescription of treatment, it is necessary to pass tests, the result of which will reveal a possible inflammatory process. After that, suitable agents are prescribed: anti-inflammatory or warming.

Within a month, bed rest is prescribed, and the patient must be laid in the “frog” position - spreading and bending his knees at the knees.

Along with this, you will need various painkillers. Sometimes metabolites are used. The rehabilitation course includes special physical education, wearing a bandage and massage.

Folk remedies

As an additional therapy, folk remedies are also used. The most common is mumiyo. It was also used by our great-grandmothers for dislocations and fractures, it was believed that mumiyo shortens the duration of treatment. You can make an ointment out of it by mixing mummy with rose oil.

Has a natural analgesic effect raw potatoes. And from the infusion of geranium, excellent baths and compresses are obtained. For a decoction, 2 tablespoons of the plant are poured with a liter of boiling water and infused for five minutes. Perhaps this is not a panacea, but as an addition to the main therapy, folk will not be superfluous.

Operation

When the transverse process of the spine is fractured, or when the spinous process of the spine is fractured, the spinal cord is affected. Such an outcome promises the most unfavorable consequences: disability and even death. In this case, the doctor may decide on an operation.

Surgical intervention is extremely rare, and only when it is required to remove a fragment that interferes with blood vessels and nerves.

In case of a fracture of the processes of the spine, it is strictly forbidden to try to sit or lift the victim, pull the arms or legs, independently adjust or stretch the vertebrae, and give medication when the victim is unconscious.

Transportation of the patient must be carried out very carefully If the stretcher is not solid and does not have a hard surface, then the patient should be placed on the stomach.

Prevention

Amateur sports are the best prevention of pathology

For preventive purposes, it is worth playing sports. Not professional, but amateur. A simple daily exercise aimed at warming up all the muscles can keep the body in good shape. This will help to avoid the terrible consequences of a fracture of the transverse process of the spine.

You should abandon sudden voltage drops and use insurance when climbing to a great height.

Conclusion

A fracture of the processes of the spinal column is one of the most dangerous injuries. This is due to the fact that it is in the lumbar region that a large number of nerve endings are concentrated, and most importantly, there is the “home” of the spinal cord.

The consequences of an injury can be a hernia, twisted posture and displacement. Doctors strongly recommend not to self-medicate, but to entrust health into the hands of professionals, because no one wants to have a disability for the rest of their days.

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 palpated. Having determined its position, it is possible to accurately count all other vertebrae.

When feeling the spine according to 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.

A fracture of the transverse process of a vertebra is a fairly common and severe injury with long-term consequences. Most often, the fracture is closed and is localized in the vertebrae L1, L2 and L3. At the same time, the strength of pain, the number of symptoms and the likelihood of complications directly depend on the location of the damage.

For example, in trauma to the thoracic spine, symptoms may be poor and the likelihood of serious complications is minimal. In contrast, damage to the lumbar spine often results in neurological disorders, severe pain and the need for surgery.

1 General description of injury

Spinal fractures are relatively rare. Statistically, with respect to all fractures of the bone apparatus, 0.5% of cases fall on fractures of the spinal column.

Fractures of the spine are different, and one of the most common is a fracture of the transverse process of the vertebra. In most cases, this pathology is localized in the lumbar spine, as it is most often subject to injury and overload.

But what is it, if we consider the disease in more detail? A fracture of the transverse process of a vertebra occurs when there is direct trauma to the spine. In rare cases, damage occurs against the background of a sharp muscle contraction (for example, with tetanus).

The fracture can be single (unilateral), multiple (bilateral) and total. With a total fracture, in addition to damage to the vertebrae, damage to the ribs occurs. All cases of fracture of the transverse process of the vertebra proceed quite hard.

1.1 Main causes of transverse process fracture

There are quite a few reasons for a fracture of the transverse process of a vertebra, but a group of factors that lead to this in about 90-95% of all cases can be distinguished.

The main causes of a fracture of the transverse process of the vertebra:

  1. Tonic convulsions (for example, during attacks with tetanus or other diseases that damage the central nervous system), excessive stress on the square muscles of the lumbar spine.
  2. A sharp lowering (precisely lowering, not lifting) of very heavy objects.
  3. Fall from a great height (especially if during the fall the victim fell on his back, although a fracture is also possible when falling on his stomach - “layer”).
  4. Blunt injuries of the spinal column - blows (for example, when practicing martial arts), blows to the back with heavy objects, a blow to the spine against the back of a chair in an accident.
  5. Any situations in which there is a sharp deviation of the body with an overload of the square muscles of the lumbar back (it is extremely difficult to avoid this situation - the body usually deviates reflexively).

1.2 Symptoms

This type of fracture is quite difficult and almost never goes unnoticed. In general, it is difficult to immediately understand from the symptoms that such an injury has been received, but there are several signs that are characteristic of it.

Symptoms of a fracture of the transverse process of the vertebra:

  • severe pain syndrome, which in some cases is not sufficiently relieved even with the use of powerful painkillers (for example, Ketanov);
  • limitation of back mobility, when trying to move your back or touch it, the pain syndrome can significantly increase;
  • Payr's symptom - when you try to bend over to the opposite side of the injury, excruciating pain occurs, sometimes leading to loss of consciousness;
  • increased pain when trying to raise the leg on the affected side of the back while lying down (stuck heel syndrome);
  • already 1-2 hours after the injury, a fever usually develops, up to 39 degrees Celsius (by the second day it usually disappears, even with minimal therapy).

1.3 Diagnostics

There are a fairly large number of types of vertebral fractures, therefore, to confirm a fracture of a specific transverse process of a vertebra, diagnostics, including imaging, are performed.

First of all, the doctor conducts a superficial examination of the patient. Sometimes palpation is performed to determine the specific localization of damage. Your doctor may run several tests to look for specific symptoms such as Payr's sign and sticky heel syndrome.

In a hospital setting, imaging diagnostics are mandatory. Minimum - X-ray in two projections. Ideally, either computed tomography or magnetic resonance imaging should be performed.

Radiography is rarely used, as it can give inaccurate results, especially if the patient has an excess of intestinal gases at the time of diagnosis (they give false "shadows" in the picture).

Primary treatment is carried out immediately upon arrival of the patient in the hospital. Full therapy is carried out only after imaging diagnostics.

1.4 The spine and its structure (video)


1.5 How dangerous is it?

A fracture of the transverse process of a vertebra is a rather serious pathology, but with adequate and timely treatment, it can be eliminated without any serious complications. However, complications can occur even against the background of adequate therapy, but this is a rarity.

An incorrectly treated or untreated fracture is fraught with the development of a severe neurological deficit, improper fusion of the muscular and bone structures of the spine, and lifelong back problems.

For example, for life the patient may be limited in movement in the lumbar region of the back. In addition, with inadequate treatment, such serious deformations of the spinal column are possible that this can lead to disability.

But the injury itself is also terrible - if the spine is damaged, small comminuted wounds of the surrounding tissues are possible. For example, ruptures of the vertebral arteries and the spinal canal. Fortunately, such complications are quite rare (no more than 1 case per 800-1000 victims).

2 Treatment of a fracture of the transverse process

Treatment of a fracture of the transverse process of a vertebra is a rather lengthy and complex event. The initial goal of treatment is to provide favorable conditions for self-fusion of the bone tissues of the vertebrae.

That is, the most important goal of therapy is support the body in the fight against damage. To do this, the first thing the patient is provided with complete rest (bed rest). For immobilization of the spinal column, a plaster cast or corset is used.

Immobilization of the back lasts up to three weeks. All this time, the patient is given medication - anti-inflammatory drugs, painkillers, drugs to enhance the regenerative and immune capabilities of the body (increased reactivity) are prescribed.

After the end of treatment, the patient is discharged from the hospital and a course of physiotherapy exercises is prescribed to develop and strengthen the spinal muscles. At the same time, rehabilitation is carried out using a corset fixing the spine to insure against stretching and re-injury of damaged tissues.

Orthopedist-traumatologist of the first category, Research Institute, 2012

Fracture of the spinous process of the cervical vertebra is an injury that rarely occurs. It is usually accompanied by damage to other tissues. A fracture of the processes of the lumbar and thoracic spine is also rare. If an injury occurs, the patient needs to be treated as soon as possible. The lack of qualified treatment is rare, but it causes death.

A fracture of the process of the spine in the cervical region, as well as a fracture of the process of the spine in the lumbar region, occurs due to direct mechanical impact on this area. The injury occurs due to a fall from a height, while diving and during a traffic accident. The occurrence of damage is promoted by increased loads on the spine and sharp flexion-extension.

Fracture of the process of the spine is a common injury for people involved in extreme sports, and it also appears in professional athletes - weightlifters.

During the exercises, a sharp contraction of the trapezius or rhomboid muscle occurs, as a result of which the spinous process suffers. Such damage prevents the continuation of professional activity.

Injury happens to boxers, like any person with a sharp blow to the head on some object. This causes a rupture of the ligament and damage to the process occurs.

Fracture of the spinous process of the spine occurs with spondylolisthesis.

A fracture of the transverse process of the spine is accompanied by the following symptoms:

  • Pain in the area of ​​the alleged injury;
  • Swelling of tissues at the fracture site;
  • Difficulties with movements;
  • When probing the injury site, pathological mobility occurs;
  • Bruising, since injury also causes damage to soft tissues and blood vessels;
  • Labored breathing;
  • problems with swallowing;
  • Lack of muscle sensitivity in the damaged area;
  • Partial loss of hearing and vision;
  • incoherent speech;
  • Unstable blood pressure.

First aid

If there is a suspicion of a fracture of the transverse or perpendicular process of the vertebral section, an ambulance team is called. Prior to her arrival, the patient is given first aid. For this, the patient is placed on his back, on a flat surface and immobilized. An ambulance is expected to arrive.

If the patient is in a place where a team of professionals cannot get, the victim will be transported independently. He is immersed in the vehicle so as not to change the position of the body. After that, he is transported to the nearest medical facility. During the trip, it is recommended to hold the patient so that he cannot fall or roll over, as this will aggravate his condition and may cause a new injury.

Diagnostics

The diagnosis is established on the basis of an X-ray examination, if we are talking about a fracture of the process of the cervical or vertebral region. Injury to the spinous process of the upper thoracic region is not detected using this device. This is due to the fact that there is a layering of the scapula and because of this, visibility is deteriorating. In this case, the diagnosis is confirmed by tomograms.

Treatment

Before starting treatment, the victim is given painkillers. The most commonly used Novocaine and Lidocaine. If a fracture of the spinous process of the cervical region occurs, then the patient is put on a corset, a Shants collar, or a cotton-gauze bandage is applied. These devices immobilize the vertebra, due to which the bone tissue grows together. With a strong pain syndrome in the area of ​​​​damage, the patient is repeatedly injected with painkillers. After all the manipulations, the person is hospitalized. He is put on bed rest for one or two weeks. The recovery period is delayed by one and a half to two months.

If a fracture of the spinous process of the lumbar or upper thoracic spine occurs, the patient is also given painkillers. Then the affected area is fixed with a bandage or corset. The patient is prescribed bed rest for several weeks.

Immobilization of the spinous process relieves pain and promotes the fusion of bone tissue. Muscle tension also disappears, and the process does not damage the surrounding vessels and soft tissues. This contributes to the convergence of edema and stop the hemorrhage.

There are several types of corset:

  • soft;
  • Rigid;
  • Semi-rigid.

The choice of this fixing agent depends on the nature of the injury. What type of corset to use for treatment is decided by the doctor.

Rehabilitation

When the rehabilitation period begins after bone tissue fusion, the patient is prescribed:

  • Physiotherapy activities;


To speed up recovery, the patient is advised to visit the pool or swim in open water during the season. Swimming promotes relaxation of muscle tissue, muscle training, and improvement of movements. Water procedures also generally have a positive effect on the state of the body. Excessive physical activity during the rehabilitation period should be abandoned.

Full recovery occurs after the patient ceases to be bothered by pain and begins to move freely.

Effects

A fracture of the transverse process of the spine of the lumbar spine, a perpendicular process of the upper thoracic to trim, as well as a fracture of the spinous process of the cervical vertebra, the consequences can have the most negative. If splicing occurs incorrectly, then this element remains in the muscle tissues in free movement. This does not always cause fears of doctors. If the patient does not feel discomfort and this does not interfere with movement, the specialist leaves everything as it is. No additional manipulations are performed.

With improper splicing, a person may be disturbed by pain that intensifies during movements.

The pain syndrome occurs due to the fact that the process remaining in the muscle tissue in a free position damages the nerve endings.

To alleviate the condition of a person, painkillers are administered to him. If their use becomes ineffective, resort to the help of a surgeon.

The front of the processes of the spine also has the following consequences:

  • neurological abnormalities;
  • Problems with the spine, in particular, a violation of its stability;
  • Violation of the activity of internal organs due to the pressure of the process on the nerve endings and blood vessels.

Surgical intervention

Surgery is performed without general anesthesia. The patient is given local anesthesia. Usually, after this, relief occurs, and the patient easily tolerates the operation. After that, the bone fragment is removed from the muscle tissue.

Fracture of the spinous process of the lumbar, cervical and upper thoracic region is rarely accompanied by complications.

Most often, tissues recover quickly after injury, but the lack of timely and qualified treatment can be fatal, so damage cannot be ignored and self-medicated.

The main function of the support is assigned to the vertebral bodies, behind which are placed the arches and processes extending from them. The mobility and flexibility of the spinal column largely depends on the ligamentous apparatus. The ligamentous apparatus consists of the yellow ligament that connects the arches of two adjacent vertebrae, the intertransverse ligaments that connect the transverse processes, and the interspinous ligaments that work with the spinous processes. The latter form a supraspinous ligament passing through the top of the spinous processes.

The spinal canal is formed from the vertebral foramina, located between the bodies and arches of the vertebrae. This canal contains the spinal cord. This is the reason that damage to the arch and process of the vertebrae can cause damage to the spinal cord, spinal nerves and spinal roots. It should be noted that with a fracture of the vertebral processes, this does not happen so often. However, the consequences can significantly spoil the quality of life.

The mechanism of injury

Fracture of the transverse process usually occurs in the lumbar region. The square psoas muscle is attached to the iliac crest, heading from there to several transverse processes of the lumbar vertebrae and the twelfth rib. A sudden contraction of this muscle can lead to a fracture of several transverse processes at once.

Falls from a great height, lowering heavy weights, causing a sharp and powerful deflection of the body, are also traumatic. A person automatically tries to counteract this movement, as a result of which the square muscle is strongly reduced and, at the place of its attachment, the transverse processes are torn off.

If there is a fracture of the transverse process on the right with subperiosteal ossification in the area of ​​attachment of the lumbar square muscle to the ilium, the risk of tearing off several or all of the transverse processes increases. Severe injuries result in a fracture line running from the pelvis through the transverse processes to the rib, which, as a consequence, may also be fractured.

Fracture types:

  • the presence of displacement;
  • no displacement;
  • splintered;
  • right hand;
  • left-sided.

Clinical manifestations

First of all, it is intense pain in the area of ​​the fracture, which becomes stronger when you try to bend over, especially in the direction opposite to the injury site. This condition is called Payr's symptom. Trying to lift the outstretched leg from the affected side while lying on your back, the pain increases. In this case, the patient is unable to raise the leg, which is called sticky heel syndrome.

The pain becomes stronger during attempts to passively bend the leg in the hip joint from the side of the lesion. If the nerve roots are affected, hypesthesia may occur, or hyperesthesia and urination will be disturbed. The diagnosis can be confirmed with an x-ray.

Damage severity

X-ray results may not always provide a true picture of the existing damage. The doctor may not pay attention to the presence of small particles of bone and set the patient up for a speedy recovery. However, the nature of the disease may be delayed, but the patient's complaints may be ignored, and he himself is accused of simulation or nervous tension.

The real cause of the damage can be recognized by examining the condition of the tissues between the debris. The presence of a large hematoma, damaged muscles, fascia, aponeurosis, stretched or torn nerves passing in this area, are the result of an injury. In later stages, traumatic exudation may occur leading to scarring and adhesions.

The doctor should not allow early mobility, since the refusal of immobilization is unacceptable. Although the doctor may try to convince the patient that his back is perfectly fine, it is not broken, and he can continue to live a full life. The patient may be prescribed early exercises, passive stretching, so that he quickly returns to a full life. However, damaged tissues should be immobilized as much as possible, reducing their functional activity in the early stages using a variety of therapeutic exercises.

Diagnostics

This type of spinal fracture produces pain, tenderness if deep pressure is applied, and soreness in the back and abdominal muscles. Pain becomes more intense under the condition of passive extension of the body to the opposite side and with active flexion in the direction where the fracture occurred.

Pain also increases due to hyperextension of the hip joint as a result of stretching of the lumbar muscles. Misdiagnosis of x-rays can also result if gaseous shadows in the colon intersect with those of the psoas muscle and transverse process of the spine. In addition, it should be borne in mind that separated transverse processes can be a congenital phenomenon.

Treatment

Treatment usually requires immobilization with a cast. However, not if there is a crack in one transverse process, and sometimes two. The lumbar region should be tightly bandaged for three weeks. Cautious activity for a spinal fracture is resolved after a few days, and you can return to full activity after a month. Recovery in these cases is quick, and the ability to work is not broken for long.

If the separation touched more than one transverse process, which indicates a significant tension in the muscles of the lower back, after one and a half to two months a plaster corset is applied, the size of which captures the lower part of the pelvis and reaches the nipples. This treatment is optimal and does not require bed rest. After a few days, you can already return to normal clothes.

As soon as the treatment allows to ease the pain, which will happen a few weeks later, a course of exercise therapy for the spinal muscles will be prescribed. A plaster corset, acting as a protection, is enough to prevent stretching of damaged tissues, which inevitably leads to a fracture of the spinal process. The plaster bandage is removed after 2 months. No other supporting devices are required as part of the treatment. The patient will be assigned gymnastics, the intensity of which is gradually increasing.