What are the ascending and descending pathways of the spinal cord. Major pathways of the spinal cord

The spinal cord is part of the central nervous system. It is located in the spinal canal. It is a thick-walled tube with a narrow channel inside, somewhat flattened in the anterior-posterior direction. It has a rather complex structure and ensures the transmission of nerve impulses from the brain to the peripheral structures of the nervous system, and also carries out its own reflex activity. Without the functioning of the spinal cord, normal breathing, heartbeat, digestion, urination, sexual activity, and any movements in the limbs are impossible. From this article you can learn about the structure of the spinal cord and the features of its functioning and physiology.

The spinal cord is laid on the 4th week of intrauterine development. Usually a woman does not even suspect that she will have a child. Throughout pregnancy, differentiation of various elements occurs, and some parts of the spinal cord completely complete their formation after birth during the first two years of life.

What does the spinal cord look like externally?

The beginning of the spinal cord is conditionally determined at the level of the upper edge of the 1st cervical vertebra and the large occipital foramen. In this area, the spinal cord is gently rebuilt into the brain, there is no clear separation between them. In this place, the intersection of the so-called pyramidal paths is carried out: the conductors responsible for the movements of the limbs. The lower edge of the spinal cord corresponds to the upper edge of the second lumbar vertebra. Thus, the length of the spinal cord is less than the length of the spinal canal. It is this feature of the location of the spinal cord that makes it possible to perform a spinal puncture at the level of the III-IV lumbar vertebrae (it is impossible to damage the spinal cord during a lumbar puncture between the spinous processes of the III-IV lumbar vertebrae, since it simply does not exist there).

The dimensions of the human spinal cord are as follows: length approximately 40-45 cm, thickness - 1-1.5 cm, weight - about 30-35 g.

There are several sections of the spinal cord along the length:

• cervical;
• chest;
• lumbar;
• sacral;
• coccygeal.

The spinal cord is thicker in the region of the cervical and lumbosacral levels than in other parts, because in these places there are clusters of nerve cells that provide movement of the arms and legs.

The last sacral segments, together with the coccygeal, are called the conus of the spinal cord due to the corresponding geometric shape. The cone passes into the terminal (end) thread. The thread no longer has nerve elements in its composition, but only connective tissue, and is covered with the membranes of the spinal cord. The terminal thread is fixed to the II coccygeal vertebra.

The spinal cord is covered throughout its entire length by 3 meninges. The first (inner) shell of the spinal cord is called soft. It carries arterial and venous vessels that provide blood supply to the spinal cord. The next shell (middle) is arachnoid (arachnoid). Between the inner and middle shells is the subarachnoid (subarachnoid) space containing cerebrospinal fluid (CSF). When performing a lumbar puncture, the needle must fall into this space so that the cerebrospinal fluid can be taken for analysis. The outer shell of the spinal cord is hard. The dura mater continues to the intervertebral foramina, accompanying the nerve roots.

Inside the spinal canal, the spinal cord is fixed to the surface of the vertebrae with the help of ligaments.

In the middle of the spinal cord, along its entire length, there is a narrow tube, the central canal. It also contains cerebrospinal fluid.

From all sides deep into the spinal cord recesses protrude - cracks and furrows. The largest of them are the anterior and posterior median fissures, which delimit the two halves of the spinal cord (left and right). Each half has additional recesses (furrows). Furrows split the spinal cord into cords. The result is two anterior, two posterior and two lateral cords. Such an anatomical division has a functional basis - in different cords there are nerve fibers that carry various information (about pain, about touch, about temperature sensations, about movements, etc.). Blood vessels penetrate into the furrows and fissures.

Segmental structure of the spinal cord - what is it?

How is the spinal cord connected to the organs? In the transverse direction, the spinal cord is divided into special sections, or segments. Roots emerge from each segment, a pair of anterior and a pair of posterior ones, which communicate the nervous system with other organs. The roots exit the spinal canal, form nerves that go to various structures of the body. The anterior roots transmit information mainly about movements (stimulate muscle contraction), therefore they are called motor. The posterior roots carry information from receptors to the spinal cord, that is, they send information about sensations, therefore they are called sensitive.

The number of segments in all people is the same: 8 cervical segments, 12 thoracic, 5 lumbar, 5 sacral and 1-3 coccygeal (usually 1). Roots from each segment rush into the intervertebral foramen. Since the length of the spinal cord is shorter than the length of the spinal canal, the roots change their direction. In the cervical region they are directed horizontally, in the thoracic region - obliquely, in the lumbar and sacral regions - almost vertically down. Due to the difference in the length of the spinal cord and spine, the distance from the exit of the roots from the spinal cord to the intervertebral foramen also changes: in the cervical region, the roots are the shortest, and in the lumbosacral region, the longest. The roots of the four lower lumbar, five sacral and coccygeal segments form the so-called ponytail. It is he who is located in the spinal canal below the II lumbar vertebra, and not the spinal cord itself.

Each segment of the spinal cord is assigned a strictly defined zone of innervation on the periphery. This zone includes a patch of skin, certain muscles, bones, and part of the internal organs. These zones are almost the same in all people. This feature of the structure of the spinal cord allows you to diagnose the location of the pathological process in the disease. For example, knowing that the sensitivity of the skin in the umbilical region is regulated by the 10th thoracic segment, with the loss of sensations of touching the skin below this area, it can be assumed that the pathological process in the spinal cord is located below the 10th thoracic segment. A similar principle works only taking into account the comparison of the innervation zones of all structures (both skin, muscles, and internal organs).

If you cut the spinal cord in the transverse direction, it will look uneven in color. On the cut you can see two colors: gray and white. Gray color is the location of the bodies of neurons, and white color is the peripheral and central processes of neurons (nerve fibers). There are over 13 million nerve cells in the spinal cord.

The bodies of gray neurons are located in such a way that they have a bizarre butterfly shape. This butterfly has clearly visible bulges - the front horns (massive, thick) and the hind horns (much thinner and smaller). Some segments also have lateral horns. In the region of the anterior horns there are bodies of neurons responsible for movement, in the region of the posterior horns - neurons that perceive sensitive impulses, in the lateral horns - neurons of the autonomic nervous system. In some parts of the spinal cord, the bodies of nerve cells responsible for the functions of individual organs are concentrated. The localization sites of these neurons have been studied and clearly defined. So, in the 8th cervical and 1st thoracic segments there are neurons responsible for the innervation of the pupil of the eye, in the 3rd - 4th cervical segments - for the innervation of the main respiratory muscle (diaphragm), in the 1st - 5th thoracic segments - for regulation of cardiac activity. Why do you need to know? It is used in clinical diagnostics. For example, it is known that the lateral horns of the 2nd - 5th sacral segments of the spinal cord regulate the activity of the pelvic organs (bladder and rectum). In the presence of a pathological process in this area (hemorrhage, tumor, destruction during trauma, etc.), a person develops urinary and fecal incontinence.

The processes of the bodies of neurons form connections with each other, with different parts of the spinal cord and brain, respectively tend up and down. These nerve fibers, which are white in color, make up the white matter in the cross section. They also form cords. In the cords, the fibers are distributed in a special pattern. In the posterior cords there are conductors from the receptors of muscles and joints (joint-muscular feeling), from the skin (recognition of an object by touch with closed eyes, a sense of touch), that is, information goes in an upward direction. In the lateral cords, fibers pass that carry information about touch, pain, temperature sensitivity to the brain, to the cerebellum about the position of the body in space, muscle tone (ascending conductors). In addition, the lateral cords also contain descending fibers that provide body movements programmed in the brain. In the anterior cords, both descending (motor) and ascending (sensation of pressure on the skin, touch) paths pass.

The fibers can be short, in which case they connect the segments of the spinal cord to each other, and long, then they communicate with the brain. In some places, the fibers may cross over or simply cross over to the opposite side. The intersection of different conductors occurs at different levels (for example, the fibers responsible for the feeling of pain and temperature sensitivity intersect 2-3 segments above the level of entry into the spinal cord, and the fibers of the articular-muscular sense go uncrossed to the uppermost sections of the spinal cord). The result of this is the following fact: in the left half of the spinal cord there are conductors from the right parts of the body. This does not apply to all nerve fibers, but is especially characteristic of sensitive processes. The study of the course of nerve fibers is also necessary for the diagnosis of the lesion site in the disease.

Blood supply to the spinal cord

The spinal cord is nourished by blood vessels coming from the vertebral arteries and from the aorta. The uppermost cervical segments receive blood from the system of vertebral arteries (as well as part of the brain) through the so-called anterior and posterior spinal arteries.

Along the entire spinal cord, additional vessels that carry blood from the aorta, the radicular-spinal arteries, flow into the anterior and posterior spinal arteries. The latter also come in front and rear. The number of such vessels is due to individual characteristics. Usually there are about 6-8 anterior radicular-spinal arteries, they are larger in diameter (the thickest ones approach the cervical and lumbar thickenings). The inferior radicular-spinal artery (the largest) is called the Adamkevich artery. Some people have an additional radicular-spinal artery coming from the sacral arteries, the Desproges-Gotteron artery. The zone of blood supply of the anterior radicular-spinal arteries occupies the following structures: the anterior and lateral horns, the base of the lateral horn, the central sections of the anterior and lateral cords.

There are an order of magnitude more posterior radicular-spinal arteries than the anterior ones - from 15 to 20. But they have a smaller diameter. The zone of their blood supply is the posterior third of the spinal cord in a transverse section (posterior cords, the main part of the posterior horn, part of the lateral cords).

In the system of radicular-spinal arteries, there are anastomoses, that is, the places where the vessels connect to each other. It plays an important role in the nutrition of the spinal cord. In the event that a vessel ceases to function (for example, a blood clot blocked the lumen), then blood flows through the anastomosis, and the neurons of the spinal cord continue to perform their functions.

The veins of the spinal cord accompany the arteries. The venous system of the spinal cord has extensive connections with the vertebral venous plexuses, the veins of the skull. Blood from the spinal cord through a whole system of vessels flows into the superior and inferior vena cava. In the place where the veins of the spinal cord pass through the dura mater, there are valves that do not allow blood to flow in the opposite direction.

Spinal Cord Functions

Basically, the spinal cord has only two functions:

• reflex;
• conductive.

Let's take a closer look at each of them.

Reflex function of the spinal cord

The reflex function of the spinal cord consists in the response of the nervous system to irritation. Did you touch something hot and involuntarily pull your hand away? This is a reflex. Did you get something down your throat and cough? This is also a reflex. Many of our daily activities are based precisely on the reflexes that are carried out thanks to the spinal cord.

So, a reflex is a response. How is it reproduced?

To make it clearer, let's take as an example the hand withdrawal response to touching a hot object (1). In the skin of the hand there are receptors (2) that perceive heat or cold. When a person touches hot, then from the receptor along the peripheral nerve fiber (3) an impulse (signaling about "hot") tends to the spinal cord. At the intervertebral foramen there is a spinal ganglion, in which the body of the neuron (4) is located, along the peripheral fiber of which the impulse came. Further along the central fiber from the body of the neuron (5), the impulse enters the posterior horns of the spinal cord, where it “switches” to another neuron (6). The processes of this neuron are sent to the anterior horns (7). In the anterior horns, the impulse switches to motor neurons (8) responsible for the work of the arm muscles. The processes of motor neurons (9) exit the spinal cord, pass through the intervertebral foramen, and, as part of the nerve, are sent to the muscles of the arm (10). The “hot” impulse causes the muscles to contract, and the hand pulls away from the hot object. Thus, a reflex ring (arc) was formed, which provided a response to the stimulus. At the same time, the brain did not participate in the process at all. The man withdrew his hand without thinking about it.

Each reflex arc has obligatory links: an afferent link (a receptor neuron with peripheral and central processes), an intercalary link (a neuron connecting an afferent link with an executor neuron) and an efferent link (a neuron that transmits an impulse to a direct executor - an organ, a muscle).

On the basis of such an arc, the reflex function of the spinal cord is built. Reflexes are congenital (which can be determined from birth) and acquired (formed in the process of life during learning), they are closed at various levels. For example, the knee jerk closes at the level of the 3rd-4th lumbar segments. Checking it, the doctor is convinced of the safety of all elements of the reflex arc, including segments of the spinal cord.

For a doctor, checking the reflex function of the spinal cord is important. This is done at every neurological examination. Most often, superficial reflexes are checked, which are caused by touch, stroke irritation, a prick of the skin or mucous membranes, and deep ones, which are caused by a blow of a neurological hammer. The surface reflexes carried out by the spinal cord include abdominal reflexes (dashed irritation of the skin of the abdomen normally causes contraction of the abdominal muscles on the same side), plantar reflex (dashed irritation of the skin of the outer edge of the sole in the direction from the heel to the fingers normally causes flexion of the toes) . Deep reflexes include flexion-elbow, carporadial, extensor-ulnar, knee, Achilles.

The conduction function of the spinal cord

The conductive function of the spinal cord is to transmit impulses from the periphery (from the skin, mucous membranes, internal organs) to the center (the brain) and vice versa. The conductors of the spinal cord, which make up its white matter, carry out the transmission of information in the ascending and descending direction. An impulse about external influences is sent to the brain, and a certain sensation is formed in a person (for example, you stroke a cat, and you get a feeling of something soft and smooth in your hand). Without the spinal cord, this is impossible. This is evidenced by cases of spinal cord injuries, when the connections between the brain and spinal cord are broken (for example, rupture of the spinal cord). Such people lose sensitivity, touch does not form sensations in them.

The brain receives impulses not only about touches, but also about the position of the body in space, the state of muscle tension, pain, and so on.

Downward impulses allow the brain to “rule” the body. Thus, what a person has conceived is carried out with the help of the spinal cord. Do you want to catch up with the departing bus? The idea is immediately realized - the necessary muscles are set in motion (and you don’t think about which muscles you need to contract and which to relax). This is done by the spinal cord.

Of course, the realization of motor acts or the formation of sensations require a complex and well-coordinated activity of all structures of the spinal cord. In fact, you need to use thousands of neurons to get the result.

The spinal cord is a very important anatomical structure. Its normal functioning ensures the entire life of a person. It serves as an intermediate link between the brain and various parts of the body, transmitting information in the form of impulses in both directions. Knowledge of the features of the structure and functioning of the spinal cord is necessary for the diagnosis of diseases of the nervous system.

Video on the topic "The structure and functions of the spinal cord"

Scientific and educational film of the times of the USSR on the topic "Spinal Cord"

The human spinal cord is the most important organ of the central nervous system, which communicates all organs with the central nervous system and conducts reflexes. It is covered on top with three shells:

• solid, cobweb and soft

Between the arachnoid and soft (vascular) membrane and in its central canal is located cerebrospinal fluid (liquor)

AT epidural space (the gap between the dura mater and the surface of the spine) - blood vessels and adipose tissue

The structure and functions of the human spinal cord

What is the external structure of the spinal cord?

This is a long cord in the spinal canal, in the form of a cylindrical cord, about 45 mm long, about 1 cm wide, flatter in front and behind than on the sides. It has conditional upper and lower bounds. The upper one starts between the line of the foramen magnum and the first cervical vertebra: in this place the spinal cord is connected to the brain through the intermediate oblong. The lower one is at the level of 1-2 lumbar vertebrae, after which the cord takes on a conical shape and then “degenerates” into a thin spinal cord ( terminal) with a diameter of about 1 mm, which stretches to the second vertebra of the coccygeal region. The terminal thread consists of two parts - inner and outer:

• internal - about 15 cm long, consists of nervous tissue, intertwined with lumbar and sacral nerves and is located in the sac of the dura mater
• external - about 8 cm, starts below the 2nd sacral vertebra and stretches in the form of a connection of the hard, arachnoid and soft membranes to the 2nd coccygeal vertebra and fuses with the periosteum

The outer, hanging down to the coccyx terminal thread with nerve fibers intertwining it is very similar in appearance to a ponytail. Therefore, pain and phenomena that occur when the nerves are pinched below the 2nd sacral vertebra are often called cauda equina syndrome.

The spinal cord has thickenings in the cervical and lumbosacral regions. This finds its explanation in the presence of a large number of exiting nerves in these places, going to the upper as well as to the lower extremities:

1. Cervical thickening extends from the 3rd - 4th cervical vertebrae to the 2nd thoracic, reaching a maximum in the 5th - 6th
2. Lumbosacral - from the level of the 9th - 10th thoracic vertebrae to the 1st lumbar with a maximum in the 12th thoracic

Gray and white matter of the spinal cord

If we consider the structure of the spinal cord in cross section, then in the center of it you can see a gray area in the form of a butterfly opening its wings. This is the gray matter of the spinal cord. It is surrounded on the outside by white matter. The cellular structure of gray and white matter differs from each other, as well as their functions.

The gray matter of the spinal cord is composed of motor and interneurons.:

• motor neurons transmit motor reflexes
• intercalary - provide a connection between the neurons themselves

White matter is made up of so-called axons- nerve processes from which the fibers of the descending and ascending pathways are created.

Butterfly wings are narrower anterior horns gray matter, wider - rear. In the anterior horns are motor neurons, in the rear intercalary. Between the symmetrical side parts there is a transverse bridge made of brain tissue, in the center of which there is a canal that communicates with the upper part of the ventricle of the brain and is filled with cerebrospinal fluid. In some departments or even along the entire length in adults, the central canal may become overgrown.

Relative to this canal, to the left and to the right of it, the gray matter of the spinal cord looks like columns of a symmetrical shape, interconnected by anterior and posterior commissures:

• the anterior and posterior pillars correspond to the anterior and posterior horns in cross section
• side protrusions form a side pillar

Lateral protrusions are not present throughout their entire length, but only between the 8th cervical and 2nd lumbar segments. Therefore, the cross section in segments where there are no lateral protrusions has an oval or round shape.

The connection of symmetrical pillars in the anterior and posterior parts forms two furrows on the surface of the brain: the anterior, deeper, and the posterior. The anterior fissure ends with a septum adjoining the posterior border of the gray matter.

Spinal nerves and segments

To the left and right of these central furrows are located respectively anterolateral and posterolateral furrows through which the anterior and posterior filaments exit ( axons) that form the nerve roots. The anterior spine in its structure is motor neurons anterior horn. Rear, responsible for sensitivity, consists of intercalary neurons back horn. Immediately at the exit from the brain segment, both the anterior and posterior roots unite into one nerve or ganglion ( ganglion). Since there are two anterior and two posterior roots in each segment, in total they form two spinal nerve(one on each side). Now it is easy to calculate how many nerves the human spinal cord has.

To do this, consider its segmental structure. There are 31 segments in total:

• 8 - in the cervical region
• 12 - in the chest
• 5 - lumbar
• 5 - in the sacral
• 1 - in the coccygeal

This means that the spinal cord has a total of 62 nerves - 31 on each side.

The sections and segments of the spinal cord and the spine are not at the same level, due to the difference in length (the spinal cord is shorter than the spine). This should be taken into account when comparing the brain segment and the number of the vertebra during radiology and tomography: if at the beginning of the cervical region this level corresponds to the number of the vertebra, and in its lower part it lies one vertebra higher, then in the sacral and coccygeal regions this difference is already several vertebrae.

Two Important Functions of the Spinal Cord

The spinal cord performs two important functions − reflex and conductive. Each of its segments is associated with specific organs, ensuring their functionality. For example:

• Cervical and thoracic - communicates with the head, arms, chest organs, chest muscles
• Lumbar - organs of the gastrointestinal tract, kidneys, muscular system of the trunk
• Sacral region - pelvic organs, legs

Reflex functions are simple reflexes laid down by nature. For example:

• pain reaction - pull your hand away if it hurts.
• knee jerk

Reflexes can be carried out without the participation of the brain

This is proven by simple experiments on animals. Biologists conducted experiments with frogs, checking how they react to pain in the absence of a head: a reaction was noted to both weak and strong pain stimuli.

The conductive functions of the spinal cord consist in conducting an impulse along the ascending path to the brain, and from there - along the descending path in the form of a return command to some organ

Thanks to this conductive connection, any mental action is carried out:
get up, go, take, throw, pick up, run, cut off, draw- and many others that a person, without noticing, commits in his daily life at home and at work.

Such a unique connection between the central brain, the spinal cord, the entire CNS and all the organs of the body and its limbs, as before, remains a dream of robotics. Not a single, even the most modern robot is yet able to carry out even a thousandth of those various movements and actions that are subject to a bioorganism. As a rule, such robots are programmed for highly specialized activities and are mainly used in conveyor automatic production.

Functions of gray and white matter. To understand how these magnificent functions of the spinal cord are carried out, consider the structure of the gray and white matter of the brain at the cellular level.

The gray matter of the spinal cord in the anterior horns contains large nerve cells called efferent(motor) and are combined into five nuclei:

• central
• anterolateral
• posterolateral
• anteromedial and posterior medial

The sensory roots of the small cells of the posterior horns are specific cell processes from the sensory nodes of the spinal cord. In the posterior horns, the structure of the gray matter is heterogeneous. Most of the cells form their own nuclei (central and thoracic). The border zone of the white matter, located near the posterior horns, is adjacent to the spongy and gelatinous zones of the gray matter, the processes of the cells of which, together with the processes of small diffusely scattered cells of the posterior horns, form synapses (contacts) with the neurons of the anterior horns and between adjacent segments. These neurites are called anterior, lateral, and posterior proper bundles. Their connection with the brain is carried out with the help of white matter pathways. Along the edge of the horns, these bundles form a white border.

The lateral horns of the gray matter perform the following important functions:

• In the intermediate zone of gray matter (lateral horns) are sympathetic cells vegetative nervous system, it is through them that communication with internal organs is carried out. The processes of these cells are connected to the anterior roots
• Here is formed spinocerebellar path:
  At the level of the cervical and upper thoracic segments is reticular zone - a bundle of a large number of nerves associated with zones of activation of the cerebral cortex and reflex activity.

The segmental activity of the gray matter of the brain, the posterior and anterior roots of the nerves, the own bundles of white matter, bordering the gray, is called the reflex function of the spinal cord. The reflexes themselves are called unconditional, according to the definition of Academician Pavlov.

The conductive functions of the white matter are carried out by means of three cords - its outer sections, limited by furrows:

• Anterior funiculus - the area between the anterior median and lateral grooves
• Posterior funiculus - between the posterior median and lateral grooves
• Lateral funiculus - between the anterolateral and posterolateral grooves

White matter axons form three conduction systems:

• short bundles called associative fibers that connect different segments of the spinal cord
• ascending sensitive (afferent) bundles directed to the parts of the brain
• descending motor (efferent) beams directed from the brain to the neurons of the gray matter of the anterior horns

Ascending and descending conduction pathways. Consider, for example, some functions of the paths of the cords of the white matter:

Anterior cords:

• Anterior pyramidal (cortical-spinal) tract- transmission of motor impulses from the cerebral cortex to the spinal cord (anterior horns)
• Spinothalamic anterior pathway- transmission of impulses of touch impact on the surface of the skin (tactile sensitivity)
• Covering-spinal tract-connecting the visual centers under the cerebral cortex with the nuclei of the anterior horns, creates a protective reflex caused by sound or visual stimuli
• Bundle of Geld and Leventhal (pre-door-spinal path)- fibers of the white matter connect the vestibular nuclei of eight pairs of cranial nerves with the motor neurons of the anterior horns
• Longitudinal posterior beam- connecting the upper segments of the spinal cord with the brain stem, coordinates the work of the eye muscles with the cervical, etc.

The ascending paths of the lateral cords conduct impulses of deep sensitivity (sensation of one's body) along the cortical-spinal, spinothalamic and tectospinal tracts.

Descending tracts of the lateral cords:

• Lateral corticospinal (pyramidal)- transmits the impulse of movement from the cerebral cortex to the gray matter of the anterior horns
• Red nuclear-spinal tract(located in front of the lateral pyramidal), the spinal cerebellar posterior and spinothalamic lateral pathways adjoin to it on the side.
  The red nuclear-spinal path carries out automatic control of movements and muscle tone at a subconscious level.

In different parts of the spinal cord, there is a different ratio of gray and white medulla. This is due to the different number of ascending and descending paths. There is more gray matter in the lower spinal segments. As you move up, it becomes less, and the white matter, on the contrary, is added, as new ascending paths are added, and at the level of the upper cervical segments and the middle part of the chest white - most of all. But in the area of ​​​​both cervical and lumbar thickenings, gray matter predominates.

As you can see, the spinal cord has a very complex structure. The connection of nerve bundles and fibers is vulnerable, and a serious injury or illness can disrupt this structure and lead to disruption of the conduction pathways, due to which there may be complete paralysis and loss of sensitivity below the “break” point of conduction. Therefore, at the slightest dangerous signs, the spinal cord must be examined and treated in time.

Puncture of the spinal cord

For the diagnosis of infectious diseases (encephalitis, meningitis, and other diseases), a puncture of the spinal cord (lumbar puncture) is used - leading a needle into the spinal canal. It is carried out in this way:
AT subarachnoid the space of the spinal cord at a level below the second lumbar vertebra, a needle is inserted and a fence is taken cerebrospinal fluid (liquor).
This procedure is safe, since the spinal cord is absent below the second vertebra in an adult, and therefore there is no threat of damage to it.

However, it requires special care not to bring infection or epithelial cells under the membrane of the spinal cord.

Spinal cord puncture is performed not only for diagnosis, but also for treatment, in such cases:

• injection of chemotherapy drugs or antibiotics under the lining of the brain
• for epidural anesthesia during operations
• for the treatment of hydrocephalus and reduction of intracranial pressure (removal of excess cerebrospinal fluid)

Spinal puncture has the following contraindications:

• spinal stenosis
• displacement (dislocation) of the brain
• dehydration (dehydration)

Take care of this important organ, do elementary prevention:

1. Take Antivirals During a Viral Meningitis Epidemic
2. Try not to have picnics in the forested area in May-early June (the period of activity of the encephalitis tick)

1. Nerves run from the spinal cord or from the brain to every part of the body. They then travel from every part of the body back to the brain or spinal cord. The brain and spinal cord are the centers of this system of nerves.
2. All parts of the body are connected by nerves. Nerve cells with their fibers make up the nervous system. When we study one nerve cell, we see that it has a long fiber at one end and short fibers at the other end. Nerve cells send impulses to each other with the help of fibers at their ends. These fibers don't really touch, but they are so close to each other that momentum can travel from one fiber to another. Physical factors have become a stimulant for nerve endings as they transfer energy from external objects to the nerve endings.
3. Thus, all nerve cells are connected to each other. There are millions of these nerve cell connections. Thus, a signal from any part of the body can reach any other part of it. In the spinal cord and brain, nerve cells are connected to each other by their connective fibers. Outside the spinal cord and brain, some long fibers are grouped together to form a nerve. Each nerve is made up of thousands of nerve fibers tied together in a single bundle, just as a cable is made up of individual wires.

brain center of the nervous system

4. We know that nerves conduct impulses to the brain. We know that the brain sends these impulses along so that they get to the right place. The brain is made up of three parts. The brain sits like a cap on the cerebellum. And the medulla oblongata is the long part of the connection between the brain and the spinal cord. The brain has some parts that do a certain job. Studying a person with accidental brain damage has helped scientists gain information about these areas. For example, they found that the area responsible for thoughts, memory, and feelings is located in the front of the brain. The area that is responsible for hearing is located on the side of the brain, and the area that is responsible for vision is in the back of the brain.
5. Numerous experiments have shown that the brain is the center of feelings and understanding. Nerve cells in the brain can be put to sleep with ether or other painkillers. Then the brain does not feel impulses from the side where the action is performed. Sometimes nerve cells in a certain part of our body can be muffled with novocaine, for example when a dentist pulls out a tooth. What novocaine does is prevent impulses from the nerve in the tooth from reaching the brain.
6. The cerebellum is the center that is responsible for the work of the muscles of the body. The medulla oblongata is the center of some of our most important activities: breathing and heartbeat, on which human life depends. The medulla oblongata is also able to control actions such as swallowing and yawning.

To control the work of internal organs, motor functions, timely receipt and transmission of sympathetic and reflex impulses, the pathways of the spinal cord are used. Violations in the transmission of impulses leads to serious malfunctions in the work of the whole organism.

What is the conduction function of the spinal cord

1. Associative pathways.
2. Commissary connections.
3. Projective nerve fibers.

Sensory and motor pathways provide a strong relationship between the spinal cord and brain, internal organs, the muscular system and the musculoskeletal system. Due to the rapid transmission of impulses, all body movements are carried out in a coordinated manner, without tangible effort on the part of the person.

What are the conducting tracts of the spinal cord formed by?

The classification of the pathways depends on the functional characteristics of the nerve fibers:

• Ascending pathways of the spinal cord - read and transmit signals: from the skin and mucous membranes of a person, life-support organs. Ensure the performance of the functions of the musculoskeletal system.
• Descending pathways of the spinal cord - transmit impulses directly to the working organs of the human body - muscle tissues, glands, etc. Connected directly to the cortical part of the gray matter. The transmission of impulses occurs through the spinal neural connection to the internal organs.

The spinal cord has a double direction of conducting paths, which provides a fast impulse transmission of information from controlled organs. The conductive function of the spinal cord is carried out due to the presence of an effective transmission of impulses through the nervous tissue.

In medical and anatomical practice, it is customary to use the following terms:

Where are the pathways of the spinal cord located?

The morphofunctional characteristic of the descending pathways of the spinal cord limits the direction of impulses in only one direction. Synapses are irritated from the presynaptic to the postsynaptic membrane.

The conduction function of the spinal cord and brain corresponds to the following possibilities and the location of the main ascending and descending pathways:

• Associative pathways - are "bridges" connecting the areas between the cortex and the nuclei of gray matter. Composed of short and long fibers. The first are located within one half or lobe of the cerebral hemispheres.
  Long fibers are able to transmit signals through 2-3 segments of the gray matter. In the cerebrospinal substance, neurons form intersegmental bundles.
• Commissural fibers - form the corpus callosum, connecting the newly formed sections of the spinal cord and brain. Disperse in a radiant way. They are located in the white matter of the brain tissue.
• Projection fibers - the location of the pathways in the spinal cord allows impulses to reach the cerebral cortex as quickly as possible. By their nature and functional features, the projection fibers are divided into ascending (afferent pathways) and descending.
  The first are divided into exteroceptive (vision, hearing), proprioceptive (motor functions), interoreceptive (communication with internal organs). The receptors are located between the spinal column and the hypothalamus.

The anatomy of the pathways is quite complicated for a person who does not have a medical education. But neural transmission of impulses is what makes the human body a single whole.

The consequences of damage to the pathways

Inside the gray matter are conductive paths that control the functioning of internal organs, as well as motor functions. Associative pathways are responsible for pain and tactile sensations. Motor - for the reflex functions of the body.

As a result of trauma, malformations or diseases of the spinal cord, conduction may decrease or stop completely. This happens due to the death of nerve fibers. For a complete violation of the conduction of impulses of the spinal cord is characterized by paralysis, lack of sensitivity of the limbs. Failures in the work of internal organs begin, for which the damaged neural connection is responsible. So, with damage to the lower part of the spinal cord, urinary incontinence and spontaneous defecation are observed.

The reflex and conduction activity of the spinal cord is disturbed immediately after the onset of degenerative pathological changes. There is a death of nerve fibers that are difficult to restore. The disease progresses rapidly and a gross violation of conduction occurs. For this reason, it is necessary to start medical treatment as early as possible.

How to restore patency in the spinal cord

Medical treatment

For additional stimulation of nerve cells, electrical impulse treatment is performed to help maintain muscle tone.

Surgery

• Elimination of catalysts that caused the paralysis of neural connections.
• Spinal cord stimulation to restore lost functions.

Traditional medicine for conduction disorders

Particularly popular are:

It is quite difficult to fully restore neural connections after an injury. Much depends on a quick appeal to a medical center and qualified assistance from a neurosurgeon. The more time passes from the onset of degenerative changes, the less chance there is to restore the functionality of the spinal cord.

You have had an accident or an illness that has unfortunately resulted in a spinal cord injury or injury (SCI). In this section, we will begin to explain how your body functions and how it is affected by SCM, which varies from case to case. You may experience only part of its effects or the full range of its effects. This book will serve as a launching pad, arouse the desire to receive new information and prompt new questions. Talk to the experts who care about you about what you think is important here.

What does the term spinal cord injury mean?

Spinal cord injury occurs when an injury interrupts the connection between the brain and the body. If this is caused by physical impact and is expressed in a divergence, rupture, cut or crush of the spinal cord, then it is called traumatic injury . It may occur due to one of the most common four types of vertebral fracture that are visible in the drawings.

The spinal cord can also be damaged as a result of multiple sclerosis or tumor growth.

Although spinal cord injury refers to damage to nerve tissues, it is easier to characterize it by the level of injury to the bony part of the spine. The affected area of ​​the spinal cord is more accurately indicated by the numbers of the vertebrae. That's why the level of your injury is named after two or more vertebrae, for example, "tetraplegia at the C5/6 level."

“The last thing I remember is getting on the quad bike to turn around. We stopped to admire the view from the highest point of Wanganui Farm. It was a hot sunny February day (it happened in the Southern Hemisphere - L.I.). I didn't notice or just didn't see the red indicator light that indicated the bike was parked in reverse. I don’t remember myself, but I was later told that the motorcycle jerked back and fell off a steep cliff. Then I seemed to be conscious, but nothing came to my mind, except for strange, dream-like memories, until two weeks later I found myself lying on my back in a small air ambulance.

Jan Popei, T5

First aid. Surgical intervention

You may need surgery to fix your damaged spine. The spine may be in an unstable state, it may be significantly deformed, or it may partially compress the spinal cord. Metal plates and fasteners are often used to fix and prevent further injury to the spinal cord. Keep in mind that stabilization surgery only restores the bony part of the spine, not the spinal cord.

Spinal stabilization

Regardless of the nature of the spinal injury, it will require immobility for some time. If the cervical spine is damaged, it is possible that you will be forced to lie on your back in traction, with devices attached to the protrusions of the skull. This will help keep the vertebrae in a stable position while fusion takes place. Typically, this stretch takes about six weeks.

For other injuries of the cervical region, it may be necessary to wear a special neck ring or the so-called Halo vest to keep the spine in a stationary state.

“If you are already in the spinal cord injury unit, listen to all the advice. Its amazing staff is too busy, they are just overwhelmed with a load of responsibilities, therefore, when expressing your requests, be patient - sometimes you need to wait a bit until you get an answer to your question. Save your energy for more important things."

Roy Dale, L4/5 injury.

Immediate consequences of trauma

In paralyzed parts of the body you will not feel excessive pressure, and with immobilized limbs you will not be able to loosen it. Therefore, in order to reduce pressure on the tissues and avoid the development of bedsores, every two to three hours you should change the position of the body, and you will have to turn over.

You will not feel the fullness of the bladder and will not be able to empty it. Until you yourself learn how to manage his work, this will be done by your doctor or nurse.

You will also need the help of the staff to empty your rectum first.

Since you yourself will not be able to move the paralyzed limbs, in order to avoid their deformation and the development of contractures, a specialist in physiotherapy exercises will deal with them.

You may experience spasticity - uncontrollable muscle tension or twitching of the limbs.

Women may notice that menstruation will stop for a while or appear earlier or later than the due date.

Men discover that erections have disappeared or that they cannot maintain them.

If you are a tetraplegic - "neck", your body's thermoregulation system may be disturbed. The temperature will be much lower than normal, and you will shiver from the cold or, on the contrary, feel hot, but you will not sweat.

You will not be able to sit straight without support, and at the very beginning you will generally need to be raised to a sitting position, and gradually and for a short time. If you are lifted too quickly, especially with a high level of spinal cord injury, you can lose consciousness altogether.

In the first weeks you may suffer from very low blood pressure, and after about a month you may experience pressure surges.

Being in a sitting position, you will realize that without outside help you will not be able to maintain balance. You will have to learn this again, relying on the sensations and controlling the limit slopes.

You may go into a deep depression or alternate between anger and guilt. This is a completely natural reaction to trauma, to the shock experienced, to the monotonous lying on your back in the hospital, to humiliating inaction, to the uncertainty of your future, to worrying about family and friends.

For several months, you will not be able to return home, start work and study, have sex, take care of children, take care of older family members, play sports and cook food. But trust me, with some preparation, you will have access to most of the things that you took for granted in everyday life before your injury. Over time, you will be able to do all or almost all the same things as before. And although life in general will be more difficult, but you will experience much greater pleasure from the results of your activities.

Some paraplegics (“spinal patients”) will be able to be discharged home in a month and a half, and tetraplegics (“collars”) in four months, but for the majority this period will last longer - from 4 to 12 months.

A few words about medical terms

Medical science has evolved over the centuries. Many of her terms are based on Latin. The language of medicine has been designed to be precise and well-defined so as not to be confusing to medical practitioners. Some terms may seem impersonal, harsh, or even negative to you.

Disabled, non-functional, incomplete, lethargic, defeated and others - all these terms describe different aspects of your condition. Remember: you are a human person who, by chance, received some bodily injury. Don't let yourself be described using "medical jargon"! If you do not understand medical terminology, calmly ask the person who uses it in a conversation with you to explain the words you do not understand.

Material borrowed from the book
"Striving Forward: How to Live with Spinal Cord Injury".
Spinal cord injury
Association of Persons with Spinal Cord Injury (PSM),
UK, May 1995.

Get to know your spine

Spine is a pillar made up of bones, ligaments and nerves and has two of the most important roles. First, it is the physical structure that connects most parts of the body, and second, it houses the spinal cord, which connects the brain to every part of the body. The spine starts at the neck and ends at the coccyx. The spine is a column of 33 individual bones, each of which is called a vertebra.

The vertebrae are stacked on top of each other and held together by intervertebral discs, ligaments and muscles. The ligaments support the spine in a stable position, and the muscles provide movements limited to a certain amplitude.

Elastic discs between each two vertebrae prevent the surfaces of the bones from rubbing against each other and serve as shock absorbers for the entire spinal column.

The spine is divided into 4 parts (departments). Each of the departments has its own name, and each vertebra has its own number.

Peripheral nerves and their functions

A pair of nerves emerge from each vertebra, and there are eight of them in the cervical region, i.e. one pair more than the vertebrae themselves. There is a hole in the center of each vertebra, and when the vertebrae are connected, a single passage is formed between them, called the spinal canal. It surrounds the spinal cord and completely protects it.

Pairs of peripheral nerves depart from the spinal cord through the gaps between the vertebrae. Each pair connects the spinal cord to different parts of the body. The figure below shows which part of the body each pair of peripheral nerves goes to.

your nervous system

The nervous system consists of the brain, spinal cord and nerves that branch off from it. The brain controls all activities of the body. Some bodily functions are automatically controlled by the brain, such as heartbeat and breathing, control over which we are not even aware of. Other functions are performed consciously, after making a volitional decision, for example, picking up an object from the floor.

Your nervous system helps control all bodily functions and can roughly be divided into two parts. The brain and spinal cord are central nervous system, a peripheral nervous system connects the central nervous system to other parts of the body. According to the principle of functional organization, the entire nervous system can also be divided into two subsystems - somatic and autonomic nervous systems.

somatic nervous system

The somatic nervous system is the main mode of communication between the brain and moving parts of the body. Its main meaning is to transmit excitation to the brain and, after this information is processed in it and a response is established, to control voluntary movements. The following are some of the functions that are checked and controlled by the somatic nervous system:

· Traffic

Sensitivity

Reflexes

autonomic nervous system

The autonomic nervous system controls the unconscious or automatic functions of the glands and internal organs. When the spinal cord is affected, the autonomic nervous system is usually also damaged. The following are the functions that are tested and controlled by the autonomic nervous system:

· Heart rate and blood pressure.

· Breathing.

· Body temperature.

· Sweating.

Trembling.

Digestion.

Functions of the rectum and bladder.

The functions of the male reproductive organs.

your spinal cord

Your spinal cord is a very complex two-way communication network that allows the brain to “communicate” with specific areas of the body, and these areas send response impulses to the brain. The spinal cord is like a telephone cable with many wires. The spinal cord is the thickness of the little finger, descends through the spinal canal from the brain and ends at the level of L1 - the first lumbar vertebra. At this point, the spinal cord branches into a bundle of nerves called ponytail .

The spinal cord has three protective spheres.

1. The outermost one dura mater is the most durable.

2. Medium arachnoid as if woven from a web.

3.pia mater very thin, but it provides waterproof insulation and keeps the brain tissue in the very center. It is called spinal tissue. It cushions and protects the spinal cord and spine from concussion and damage.

The spinal cord itself in section has the appearance of a butterfly with two clearly marked zones - gray matter and white matter. The most important function of the spinal cord is to carry messages from your body to your brain and from your brain to different parts of your body.

“I was injured in 1995 at Cave Creek when an observation deck collapsed and 18 people fell off a 35-meter cliff onto sharp rocks. I was one of four survivors. Fortunately, I do not remember the accident itself, nor half of the time spent in resuscitation. In addition to C6/7 incomplete tetraplegia, I broke 16 bones, including the lower jaw in three places, I had a rupture of the rectum and damage to the skull. I spent a year in the spinal cord injury unit at Barwood, intending to go into more rehab, but actually it only started when I plunged back into real life.”

Steve Hannen

Nerve connections and signals

These messages, or signals, travel along pathways that run through the white matter of the spinal cord. As in an escalator, these paths have a well-defined direction of movement. Some are designed to send messages to the brain, others in the opposite direction.

The three different types of messages that travel through the spinal cord are:

1. SENSITIVITY OR SENSOR SIGNALS.

2. MOTOR OR MOTOR SIGNALS.

3. PROTECTIVE SIGNALS OR REFLEXES.

Sensory Signals

Sensory signals are sent to the spinal cord from different parts of the body, say from the hand. The spinal cord then sends them to the brain. When they reach the brain, they are perceived as sensitivity, i.e. touch, pain, high or low temperature.

There is another vital sensation that you did not know about before. In Latin it is called proprioception . It subconsciously informs you in what position your limbs and joints are. Proprioceptive signals inform the brain about the position of the body so that the brain can accurately coordinate its unconscious movements, for example, that it is time to change the position of the hand.

motor signals

Motor messages are generated in the brain and transmitted through the spinal cord. The spinal nerves send messages to the appropriate parts of the body, and these signals control most of the muscles.

1. Pain signal from the leg. 2. Reflex reaction skipped by the spinal cord. 3. The brain is convinced of the causelessness of panic and stops reflex movements.

reflex signals

Your body has an amazing defense mechanism built into it. It turns out that not all messages from different parts of the body go all the way to the brain. The spinal cord is able to make independent decisions in this regard. For example, if you step on a button, the skin sends a sensory message about it. If this message is regarded as a signal of panic, the spinal cord will send a reflex signal to the muscle group where it originated, and the leg will immediately pull away from this source of pain, without forcing you to think, i.e. it will happen automatically. But the original message will still reach the brain, and it will limit the strength of the reflex reaction in order to slow down the movement of the leg.

What happened to my nervous system

Motor signals cannot pass through the injury, so the brain cannot control muscles below the level of the injury. In the same way, sensory signals do not travel from below to reach the brain, so you do not feel heat or cold, pain or pressure. Ask your doctor to show in this picture where your affected area of ​​the spinal cord is located.

Reflex signals may still loop or bounce off the spinal cord, but the brain is no longer able to suppress reflex movements. This leads to muscle spasms, spasticity or "spastics" . Remember that motor, sensory and reflex signals, once running between the brain and body, will never stop, they simply won't overcome the level of your trauma.

Damage to the spinal cord does not prevent the muscles located below the level of the injury from receiving blood and nutrition. After an injury, you may experience changes in breathing, temperature, heart rate, and blood pressure. Most likely, you will also feel changes in the work of the rectum, bladder and genitals. The novice patient will be very worried about not knowing how the trauma will affect sexual life and the ability to have children. This topic is discussed in more detail in a separate chapter below.

spinal shock

Immediately after the injury, the spinal cord may be in a state of shock. During this time, reflexes, movement, and sensation below the level of injury may be absent. Spinal shock in some may last several hours, others several months. It is because of the shock in the early stages after injury that we cannot determine exactly which bodily functions have been lost. It won't be until a few weeks after the shock is over that you may feel a return to some movement or sensation, but this varies from person to person.

Restoration of any form of reflex activity below the level of injury indicates an exit from the state of spinal shock.

Reflexes and spasticity

Before injury reflex activity was a normal function of the spinal cord. This immediate action system protects the body and prevents self-injury, such as keeping away heat sources.

Painful squeezing of the muscles or pain in the skin cause the appearance of sensory signals emanating from the nerve endings in this area of ​​the body. Weak signals follow first to the spinal cord and then to the brain. Stronger signals are reflected immediately from the spinal cord back to the muscles, which makes it possible to remove a part of the body from the source of pain or discomfort. The brain controls the defensive reflex by limiting the response to a single movement of moderate force.

If your spinal cord is affected at the T12 level or higher, your protective reflexes are most likely preserved and continue to operate. Signals from the spinal cord directly to the muscles are still being reflected, but the brain cannot weaken or control the muscle movements. In this situation, a muscle spasm occurs. In case of injury at the level of T12 and below such spasticity usually does not happen.

You probably cannot imagine that "spastic" can be a positive phenomenon, but, take my word for it, it can bring considerable benefits to spinal patients. So, spasticity indicates that something is wrong with you. After a while, you will learn to distinguish between different types of spasticity as signals that will indicate exactly what happened, for example, to fill the bladder. Spasticity also keeps the muscles of the limbs toned, promotes blood circulation, and helps the bladder and bowels work.

For example, a full bladder will try to send sensory signals to the brain that it needs to empty. This message will not reach the brain, but it will excite a reflex signal from the spinal cord, which will give the command to the muscles of the bladder to empty.

“I was at home and while cleaning the windows I fell off the roof of the carport. I am convinced that the rehabilitation was successful for me. I had advantages: this is my age of 55 years, my qualifications, which helped to realize and understand the sad events. I constantly trained to make it easier to adapt to life. I am an open, honest person and have never lost heart. I was interested in everything that would help me survive, and in order to avoid any embarrassment or misunderstanding, I chatted frankly with elderly nannies. I also had great support from my family and friends.”

Robin Paul, T12

your intestines

Immediately after the injury, your intestines will be sluggish, atonic, i.e. his muscles will not contract, although he will continue to function, eat and absorb nutrients. Later, depending on the level of injury, you may develop or spastic intestines reflex type , or your intestines will remain lethargic, atonic .

Spastic bowel

With an injury above T12, your bowels are likely to empty reflexively. When the spinal cord is affected, the feeling of filling the rectum does not reach the brain, but it does reach the spinal cord. As the rectum fills and stretches, it puts pressure on the nerve endings in the intestines. This triggers a sensory signal that is sent from the gut through sacral nerves of the sacral plexus to the muscles of the intestine. At this point, it is shrinking.

flaccid bowel

In case of injury at the L1 level and below, the intestines most likely will not have reflex activity. This is because at this level, the spinal cord ends, and signals from the nerve endings in the rectum cannot travel along the nerves of the sacral plexus to the spinal cord. The muscles of the intestine will not contract, but the annular muscle of the anus (anal sphincter) stay relaxed.

You will have to learn how to regulate your food intake and bowel movements differently. A proper regulation program will help you regain control of your bowel and maintain good health. This is discussed in more detail below in the chapter.

your bladder

Urination is one of the most important body care activities. “Go take a pee” is the final stage of a simple but important process, because the excretion system is constantly working and monitoring the amount of fluid in the body and its waste products. It serves as a kind of filter that purifies the blood and facilitates blood flow.

Damage to the spinal cord somehow affects the ability to urinate normally. Even the smallest violations will cause a break in the "control chain" in this system, but there are a number of methods that allow you to establish control over the work of the bladder. Learning the correct techniques for this adjustment will help you, now and in the future, avoid infections, kidney and bladder stones, and other complications. This is discussed in more detail in the dedicated chapter below. Bladder.

“Don't let the thoughts that you can't do something into your mind. Achieve in various ways to complete a particular task, and after hundreds of unsuccessful attempts, you will find a way that will eventually work. The first time I spent half an hour fastening my jeans, the second time it took me 20 minutes, and now it only takes 25 seconds. At first, everything was difficult for me, but now I can do almost everything.

Tim Johnson, С6/7

Skin and sensitivity

Pairs of peripheral nerves that branch off from the spinal cord carry sensory messages to the brain from well-defined areas of the body. When talking about sensitivity, such areas of the skin are called dermatomes . They are outlined very clearly and help doctors determine exactly which part of the spinal cord is affected. The relative positions of the vertebrae, peripheral nerves, and dermatomes can be understood from the corresponding figures.

Each pair of peripheral nerves also sends motor signals to groups of muscles located near the corresponding dermatome. When talking about motor messages, these same areas are called myotomes .

If you have installed full break , this means that at the level of your injury there is a complete blockage of neural connections. If a break incomplete , then the blockade is only partial, and below the level of injury, sensitivity and movement are partially or completely preserved.

By checking the function of various muscles and skin sensitivity, doctors usually determine the level of your injury.

If you have no sensitivity below the level of injury, the brain does not receive signals from these areas of the skin about whether the blood supply is sufficient for them, whether they are overheated or cooled, whether there are cuts, punctures or abrasions on them.

If you stay in a monotonous sitting or lying position for a long time, small areas of the body experience compression, in which very thin blood vessels that supply oxygen and food to the tissues are pinched. Most often this occurs over bony prominences, i.e. where the bones are closest to the surface of the skin. If such starvation from lack of “fuel” lasts for a long time, tissues will begin to die and develop bedsore .

Damage to the spinal cord means that you must quite consciously make it a rule to take good care of your skin. Since you do not react to possible skin damage, now you must anticipate them in advance and prevent their occurrence. To keep your skin looking its best and stay away from the hospital, you'll have to learn the skills relieve pressure by pushing the body away from the bed or stroller, turning or any other change in body position. Read the chapter carefully Skin covers.

Recovery map

Remember: This is just a sample! Start getting up only after complete healing. It takes at least a week to treat a duodenal ulcer of the second stage of development. Do not start the task the next day if the skin condition worsens or the improvement stops.

Hope for recovery and healing

Recovery

As we have said, the outcome of your injury is initially masked by spinal shock. You may be tempted not to participate in rehabilitation, hoping that as soon as the injury subsides, all bodily functions will recover by themselves.

It is true that with the same level of injury, especially with incomplete interruption of the spinal cord, the end results may be different. But the hope of regaining lost function should not keep you from participating in rehabilitation. If you work hard now, it will be easier for you to use the restored features in the future. Plus, you'll get out of the hospital sooner!

Complete cure

Of course, you want to know what is the probability of your complete cure. Spinal cord injury is not a disease in itself, even if it is sometimes caused by a disease, and therefore the word "cure" cannot be applied to it. As with other injuries, doctors treat the symptoms and consequences of the injury as successfully as modern medicine can. Spinal cord injury is one of the most complex bodily injuries. At the time this book was written (2004 - L.I.), there were about 200 different international scientific programs studying all aspects of spinal cord injury and restoration of the functions of the spinal cord (its regeneration ). There are many encouraging discoveries, but so far none of these studies can help to successfully restore lost functions with a complete rupture of the spinal cord.

It is reasonable to assume that if the constant progress of medical technology allows surgeons someday to restore the functions of a damaged spinal cord, then most likely these procedures will initially be applied only to "fresh" injuries. This is due to the fact that after an injury, the body itself additionally destroys the site of injury. It seems that the first successes along this path will be associated precisely with the prevention of this "corrosion" of the affected area, which occurs in the first two days after the injury. As for the long-standing injured, it will be much more difficult to restore them than fresh injuries.

After injury, affected nerve cells lose calcium ions and other substances that destroy the protective myelin coating of nerves and other cell membranes.

This chain reaction damages nerve cells near the site of injury that might otherwise be repaired. Such damage appears to be exacerbated by the lack of oxygen. Much research is directed specifically at preventing these secondary injuries in order to lessen the overall impact of injury. If you would like to learn more about this, you can refer to the many publications and websites dedicated to the results of spinal cord injury research.

Keep in mind that no two spinal cord injuries are the same. Depending on the cause of the injury, some spinal cord fibers may remain intact. The following terms are used to classify the type and degree of damage.

We are not going to deprive you of hope for a final cure, but at the same time we want to inspire you to immediately do everything in your power for an active and joyful life! If you sit and wait for your “maybe”, then everything will end in deep disappointment, and you will miss the opportunities that exist now.

Important Concepts

Spinal cord injury

Any injury to the spinal cord is called defeat. If it is caused by mechanical trauma, it is called traumatic injury.

Damage level

Spinal cord injuries differ in medicine by the level of damage to the spinal cord.

Damage level bone part spine described by its department and vertebra number. (For example: cervical region, 6th and 7th vertebrae = C6/7).

Neurological level indicates which nerves are affected; this is followed by an indication of complete or incomplete defeat.

Complete defeat

A complete lesion means that there is a complete blockage of nerve conduction at the site of injury.

Incomplete defeat

An incomplete lesion means that there is only a partial block of nerve conduction, and below the level of injury, some (or all) movement and sensation remain intact. The degree of their safety depends on how badly your spinal cord is damaged. There are 5 main types of incomplete lesions:

Central cortical syndrome

Damage to the central part of the spinal cord usually occurs with trauma to the cervical spine. You experience complete immobility of the arms, although the movements in the legs have partially remained. Sensitivity on the hands is usually located randomly. The bladder and intestines usually remain partially intact, and recovery is possible starting from the lower extremities moving up.

Posterior cortical syndrome

With damage to the posterior part of the spinal cord, muscle strength and pain temperature sensitivity may be preserved, but difficulties in coordination of movements may occur. This type is very rare.

Brown-Sigard Syndrome

This type occurs with a lateral lesion of the spinal cord. On the affected side of the body, muscle strength may be weakened or absent altogether, and the sense of pressure and position of the body may be disturbed. On the opposite side, there is a loss or weakening of pain and temperature sensitivity, but movements, a feeling of pressure and body position, as a rule, remain.

Cauda equina syndrome

The cauda equina is a bundle of nerves that radiate from the lower part of the spinal cord. Cauda equina injury can cause loss of muscle strength and sensation in the lower extremities in the form of patches. The intestines and bladder are usually seriously affected. If the nerve roots of the cauda equina are not completely crushed, functional recovery may occur in 12-18 months.

Paralysis

The word paralysis generally refers to the inability to freely move individual parts of the body or feel them.

Paraplegia

The term paraplegia characterizes paralysis from the level below the cervical vertebrae ( below T1). Persons with paraplegia ( paraplegics, spinalists) suffer from partial or complete paralysis of the arms or legs.

Anterior cortical syndrome

When the anterior part of the spinal cord is damaged below the level of injury, there is usually a complete or partial loss of movement, as well as pain, temperature and tactile (tactile) sensitivity. You may retain deep pressure sensitivity and a sense of body position.

Tetraplegia (quadiplegia)

Persons with lesions of the cervical region, "collars", suffer from partial or complete paralysis of the arms and legs. Abroad they are called tetraplegics (tetra - four, Greek - L.I.), and in America quadriplegics (quad- four, lat.- L.), since all four limbs are affected.

Neurological lesion

Any injury in which the spinal cord is damaged is called " neurological lesion". A back injury in which the spinal cord is not affected is called an "injury without neurological involvement". This means that the nervous system is not disturbed and remains normal. Most patients with such an injury will not be seen in spinal (neurosurgical) hospital units, but by orthopedic specialists.

“When I was in rehabilitation, I learned a lot from other spinal and cervical specialists who came to the department for re-examination.
They provided me with a lot of useful advice and information. It seems to me that I paid more attention to them also because they were wheelchair users. I probably had more confidence in them.”

Keith Jarvey, С4/5

“I remember the first time I got into the car. I was able to travel by myself, which means I became more independent. But you still had to get in and out on your own! First I made sure no one was around. I was out of town with friends and decided to go home alone. They saw me getting into the car, they offered to help, but I had to do it myself. Getting into the car is easy, but getting out is much more difficult. So I went home, and spent 15-20 minutes to get out of the car. Now it takes 1 minute!”

Tim Johnson, С6/7

“I remember well how we drove from the airport to the spinal ward after what seemed like a long and slow ride in the ambulance. All I could see along the way were the tops of street lamps. My wife was with me, and we waited in the corridor for a very long time, completely unaware of what was happening and what we should do. The wife, usually not very emotional, but then she was in the early stages of pregnancy, which we, however, did not yet know about, and therefore she was extremely excited and ready to sob. This was a bad start, but then gradually everything settled down and, for the good of the case, turned into friendly care on her part.

Jan Popei, T5