Reconstructive and Stabilizing Interventions in Aggravation of Myelopathic Syndrome in a Remote Period of Complicated Spinal Trauma

F.I. Amin, A.V. Baskov, G.M. Kavalersky, M.B. Boev, E.L. Beloborodov

(Faculty of Neurosurgery of the Russian Medical Academy of Postgraduate Education, Moscow;
Sechenov Moscow Medical Academy, Moscow;
Municipal Clinical Hospital N 19, Moscow)

Reconstruction of a vertebral canal by means of decompression of a spinal cord, removal of cicatrices and draining of intramedullary cysts is considered to be necessary. It is used in compression of the spinal cord by bone fragments and an aggravating scarry-adhesive process, which leads to impaired hemodynamics and a block of a subarachnoid space in a remote period of spinal trauma.

The results of our study, carried out on 120 cases, confirmed, that elimination of any elements of the spinal cord compression with restoration of liquor circulation in a remote period of trauma had a positive effect on some of its lost segmental functions and prevented progression of myelopathic syndrome. It resulted in considerable improvement of life quality of this category of patients.

Indications for surgical intervention included augmentation of myelopathic syndrome, aggravation of neurological disorders, manifesting themselves in pain and spastic syndromes, pelvic and trophic disturbances. All the cases had inferior paraplegia or gross paraparesis.

In case of a subarachnoid space block with minor disorders of blood circulation, meningomyeloradiculolysis was performed. When there was occlusion of the anterior spinal artery, it was combined with omentomyelopexy by a free omental graft on a vascular pedicle of the intercostal artery. Reconstruction of the vertebral canal with tanspedicular stabilization was made in ventral or ventrolateral compression of the spinal cord.

There were sensitivity improvement, complete or partial regression of pain syndrome, decreased spasticity, a better trophic function of the skin, reduction of inflammatory complications on the part of urinary tracts.

Taking into account the obtained results, it was concluded, that reconstructive operations with use of meningomyeloradiculolysis in combination with omentomyelopexy or without it, stabilization and spondylodesis of an injured spinal segment led to improvement of life quality in 96.3% of cases. Pelvic functions improved much better in transplantation of an omental graft, as compared to conventional meningomyeloradiculolysis.

We are eager to continue our research in this field. Development of new technologies and materials, promoting restoration of conductive functions of the spinal cord in a remote period of trauma can lead to considerable improvement of treatment results in this category of cases.