Compressio spinalis, or spinal cord contusion, is the most severe form of three possible degrees of severity of spinal cord injury. It usually occurs as a result of an unstable vertebral body fracture caused by an accident or because of a traumatic herniated disc. Spinal cord compression involves irreversible neurologic damage, resulting in persistent sensory and motor deficits that are not correctable according to the current state of neurologic medicine.
What is compressio spinalis?
Spinal cord compression is the term used to describe a spinal cord injury in which irreversible damage to the nerves occurs as a result of acute or chronic compression of the spinal nerves. It is the most severe of three categories of spinal cord compression. Spinal cord compressio is also referred to as spinal cord contusion. De facto, the most severe form of spinal cord compression means a total loss of sensory and motor abilities in the areas of the body innervated by the injured and compressed nerves. This means that muscle paralysis and complete loss of sensation in the affected regions are the result. Such serious spinal cord injuries can occur as a result of accidents involving vertebral comminution or extreme disc herniation (discus prolapse). Permanent, severe compression of the nerves of the spinal cord can also result from space-occupying hematoma or tumor.
Causes
Spinal cord compression can be caused by external or internal effects. External effects usually result from traffic, sports, and household accidents involving severe, unstable vertebral fracture or vertebral dislocation, resulting in crushing of the spinal cord (medulla spinalis, myelon). In extreme cases, demineralization of the vertebral bodies due to osteoporosis or other diseases can cause an unstable vertebral fracture even without any apparent reason. External effects such as blunt trauma can cause a compressio spinalis without a vertebral fracture. For example, there may be hemorrhage in or around the spinal canal, resulting in severe compression of the spinal cord nerves due to spatial stress. Spatial stress that causes severe compression of the medulla spinalis can also result from tumors. Other causes of spinal cord contusion include extreme disc herniation or, very rarely, an unintended complication of a medical procedure.
Symptoms, complaints, and signs
Acute compressio spinalis is accompanied by severe neurologic disturbances. Sensory deficits in the form of numbness in the affected areas of the body are symptomatic. Motor failures of affected muscle parts are equally typical. The inactivity of the muscle areas due to the lack of nervous impulses very soon leads to muscle atrophy, a breakdown of the contractile muscle cells. The breakdown of muscle tissue is a normal process when the muscle in question is either not being used or cannot be used or moved due to neurological or other reasons. Typically, a spinal cord contusion results in segmental neurologic deficits depending on the location of the lesion. Paraparesis or even tetraparesis often presents, paralysis of the legs or all four extremities. Also symptomatic is a pathologically increased reflex response in certain protective reflexes because motoneurons that serve to self-regulate reflexes have failed. In this context, pyramidal tract signs are particularly noteworthy and can be identified by a series of typical reflex responses.
Diagnosis and course
When compressio spinalis is caused by violence as a result of an accident, it is usually associated with further physical damage such as fractures, unconsciousness, and similar symptoms. A diagnosis is then usually only possible taking into account the other injuries. The most important signs that may indicate a spinal nerve contusion are a loss of sensory and motor abilities, for example, in the legs. Of course, an examination of the abilities can only be done if the other injuries of the patient, who is usually in shock, allow it. In most other cases, the development of compressio spinalis is gradual, so that the less serious stages of commotio spinalis and contusio spinalis are passed through first.These two precursors of spinal nerve crush are noticeable by faint neurologic signs that gradually increase in severity depending on the cause.
Complications
Very severe and serious complications occur with spinal nerve compression. These are usually irreversible and cannot be treated or repaired. Because of the injury to the spinal cord, ordinary movements are no longer possible for the patient, and motor skills are limited. The quality of life decreases extremely due to the restrictions and in many cases the affected person is dependent on the help of other people. In many cases, there is also a deterioration of the muscles. These can be moved partially or no longer at all. Legs and arms are also paralyzed, so that the patient suffers from severe movement restrictions and is usually also dependent on a wheelchair. Compressio spinalis can also cause psychological discomfort, which can lead to depression or suicidal thoughts. Especially young people are affected by psychological problems due to the restrictions. It is not possible to treat compressio spinalis medically, so the affected person has to live with the limitations for the rest of his or her life. For many patients, psychiatric care is necessary. Life expectancy is not reduced if no other complications have occurred with the cause of the compressio spinalis.
When should you see a doctor?
If numbness and other signs of compressio spinalis are noticed in association with a vertebral fracture or severe disc herniation, emergency medical attention should be sought immediately in all cases. In the event of motor failures of certain muscle parts, the affected person must also be treated immediately or should be taken directly to the nearest hospital. If the complaints occur as a result of an accident, there is usually further physical damage, such as fractures or lacerations, which must be treated immediately. The victim himself or the first responders on the scene should call the emergency medical services. Accompanying first aid should be administered to the injured person. After initial treatment of compressio spinalis, a longer hospital stay is usually indicated. Depending on the severity of the injury, in many cases the affected person is dependent on the help of others. Physiotherapeutic treatment is usually necessary, as is close medical monitoring of the injury. The advice of a therapist should also be sought if psychological symptoms are present.
Treatment and therapy
For any spinal nerve compression, the primary goal is to relieve the neurons of compression pressure, if other injuries allow. The therapeutic goal applies regardless of the severity of the compresssion. It cannot be determined a priori whether the lesions of the nerves are reversible or irreversible. To be on the safe side, it should first be assumed that the damage is reversible. Certainty as to whether the neuronal damage is at least partially reversible often does not exist for a long time. In cases where spinal cord compression is slow to develop, there is an opportunity to respond to initial signs. Initial symptoms usually consist of non-specific signs such as decreased sensitivity, occasionally “ant tingling,” and motor dysfunction. Such symptoms should be taken as an opportunity to make a precise diagnosis of the causes of the problems so that they can be addressed at an early stage. This means that signs indicating developing spinal nerve compression can also be considered early indicators of a specific underlying condition and open up the possibility of early treatment of the diagnosed underlying condition.
Outlook and prognosis
Compressio spinalis has an unfavorable prognosis. The disease causes irreparable damage, so that a cure can be ruled out with current medical options. The functionality of the damaged nerves cannot be restored or taken over by other nerve fibers. Motor disorders develop, leading to a deterioration of muscle strength. Since many muscles are no longer activated, they atrophy and regress. The general well-being decreases and often the patient is dependent on a wheelchair or assistance in everyday life.Compressio spinalis causes many changes in the life of the affected person. In addition to the physical changes, social or professional problems often occur. These worsen the general state of health. If the patient manages to adapt to the circumstances and restructure his life well, the well-being increases again. A good and satisfied life with the disease then becomes possible. Otherwise, in addition to further physical impairments, there is also a risk of psychological disorders. The risk of developing depression or melancholia is greatly increased. Often suicidal thoughts emerge and the meaning of life is lost. Due to these mental obstacles, the prospect of improvement of the overall situation decreases. The patient has a much better prognosis if he faces life optimistically despite the adversities.
Prevention
Direct preventive measures that would be suitable to prevent compressio spinalis are only possible to a limited extent. Conditional preventive measures include, for example, passive accident protection using airbags, protective clothing (for example, back protectors), and other safety systems. Safety training in occupational and sporting activities, which are accident-prone activities, can also be counted among indirect preventive measures, because the risk of an accident and the risk of suffering a serious spinal injury are minimized.
Here’s what you can do yourself
If compressio spinalis is present, self-help measures are limited. In everyday life, the physician’s guidelines and instructions should be followed. Supportive for the healing process are slow and gentle movements. Physical strain should be controlled and should not be too strong. Incorrect postures or one-sided strain should also be avoided. These measures do not immediately alleviate the existing symptoms, but they do prevent them from increasing and thus causing further impairment. It is helpful if the affected person keeps his weight within the range of normal weight. Being overweight or obese puts a strain on the bones and contributes to an undersupply of the nerves. In the case of existing contusions, the healing process is slowed down as soon as there is too much body weight. Since the disease is often associated with a loss of joie de vivre, a reduced sense of well-being and, as a result, an increase in psychological complaints, the affected person should strive to achieve emotional stability and maintain a stable social environment. Optimism and confidence help in maintaining well-being. Daily routines need to be restructured and adapted to the available opportunities. If possible, this should be done with a positive attitude and in close cooperation with people in the close environment.