Surgery of Spinal Injuries: Tactics of Treatment in Associated Trauma

A.S. Ermolov, A.A. Grin, Yu.S. Ioffe, N.N. Nikolaev, D.V. Bublievsky, V.V. Krylov

(Sklifosovsky Research Institute of Emergency Care, Moscow)

The study goal was determining tactics of treatment in spinal injuries, watched in cases with associated trauma. Associated injuries account for about 50% of spinal trauma.

Materials and Methods. There were 127 cases with associated spinal trauma (AST), treated in the Sklifosovsky Research Institute of Emergency Care during 01.01.00-31.12.02; 113 of them demanded an operation on the spine and spinal cord. It was performed in 98 cases. A diagnostic algorithm included general and neurological examinations, X-ray, myelography and CT. Urgent operations were made in 71 patients. They were performed in delayed or intermediate periods in 27 cases. Modern fixing devices were used in 61 patients.

Results. Surgical tactics was chosen after assessment of a patientís general condition and a character of injuries. Indications for urgent operations were compression of the spinal cord or its roots and/or an unstable fracture of the spine. Unstable fractures without neurological disorders allowed to perform operations after complete stabilization of a patientís state. Treatment tactics and an operation volume were determined with taking into consideration associated pathology (injuries of thoracic and abdominal organs, bone fractures, shock development).

Operations were contraindicated in an extremely severe state of a patient, manifesting itself in hemodynamics instability, coma, anemia (hemoglobin of less than 70g/l), renal and/or hepatic insufficiency, fat embolism, pneumonia, unfixed fractures of extremities (in operations with using a posterior approach).

Fatal outcomes (18.3%) were conditioned by severe thoracic trauma with contusion of a lung and heart, fractures of pelvic bones, severe craniocerebral trauma and accompanying pyo-septic complications.

Conclusions. One-stage or successive operations on the spinal cord and spine with its fixing within 72 hours promote early activity of cases and reduce mortality, caused by secondary pyo-septic complications and embolism.