A System of Surgical Treatment of Casualties with Acute Injuries of the Spine and Spinal Cord

A.K. Dulaev, V.P. Orlov

Chair of Traumatology and Orthopedics Medicomilitary Academy, Saint Petersburg, Rusia

 

A problem of treatment of casualties with complicated and non-complicated injuries of the spine and spinal cord is still urgent. Our study was based on results of surgical treatment of 476 patients with uncomplicated (298 cases or 62.6%) and complicated (178 cases or 37.4%) injuries of the spine and spinal cord. Male patients (217 cases or 78.6%) and individuals, engaged in manual labor (183 cases or 66.3%), were predominant. A mean age was 31.5±4.7 years. Injuries were caused by falling from different height (63.4%), car crashes and road accidents (21.4%). The analysis of a trauma character showed, that the majority of patients was represented by casualties with multiple and associated injuries (62.7%), who had traumatic shock of different severity on admission (57.2%). Interventions were subdivided into two main groups: 1) Decompressive-stabilizing operations; 2) Surgical correction and stabilization of the spine. All the patients were followed up during 1-6 years.

The study results were analyzed from the following points of view:

  1. An optimum term of surgical intervention;
  2. An optimum volume of surgical intervention;
  3. Optimum methods, used for decompression of neurovascular structures of a vertebral canal;
  4. Optimum methods of spine correction and stabilization.

It is expedient to perform decompressive-stabilizing interventions in patients with trauma of the spine and spinal cord during the first hours of their stay in a specialized department. It should be done only after shock arresting, achieving a state of at least moderate severity, performing urgent life-saving operations. An optimum term of stabilizing intervention in non-complicated injuries of the spine is the 2-3 day since trauma.

A volume of emergency operation on vertebral structures is strongly dependent on integral severity of both trauma and a patient's state. In case of severe multiple and associated trauma, it is expedient to perform decompressive-stabilizing and stabilizing operation, using only posterior or posterolateral approaches.

Optimum approaches to substances, compressing the spinal cord, its roots and major arteries are as follows: anterior compression - an anterior approach; posterior or lateral compression - a posterior approach; anterior and posterior compression - a combined approach. The only exception is patients with severe multiple or associated trauma, when posterior or posterolateral approaches to a compression zone have no alternative.

A method of surgical correction and stabilization of the spine should be chosen in accordance with a type of vertebral trauma, experience of a surgeon and available equipment. If a surgeon possesses high skills and there are a lot of systems for spine stabilization, use of the most advanced and effective methods, i. e. transpedicular or anterior fixation, is preferable.