B.V. Gaidar, V.E. Parfenov, A.K. Dulaev, V.P. Orlov
(Medicomilitary Academy, Saint Petersburg)
Surgical treatment of patients with sequelae of backbone trauma is a serious problem of modern orthopedics and neurosurgery. Its importance is conditioned not only by a high rate and severity of such trauma, but also by absence of an effective system of rendering specialized care to casualties with acute backbone and spinal trauma in our country.
The authors describe their experience of surgical treatment of 218 cases with different sequelae of trauma of the spine and spinal cord. There were 82 cases (37.6%), who had partial neurological deficit against a background of compression of the spinal cord or its roots. The rest 136 patients (62.4%) were admitted to the hospital with complaints of persistent marked pain syndrome and static disorders, caused by instability of the spine (82 cases, 37.6%), imperfect consolidation of a broken vertebra (9 cases, 4.1%), posttraumatic stenosis of a vertebral canal (36 cases, 16.5%), posttraumatic stenosis of a vertebral canal (36 patients, 16.5%) or considerable deformity of the spinal column (39 cases, 27.1%). These data demonstrate, that the above pathologic states were associated. Patients with persistent compression of neurovascular elements of the spine were subject to decompressive operations with anterior (67cases) or (and) posterior (39cases) approaches, revision of the spinal cord and its roots, meningoradiculolysis. Autoplasy of roots of the horseís tail was performed in 2 cases. The spine instability was treated with different methods of internal fixation (82 patients), as well as anterior (51 patients) or posterior (13 patients) spondylodesis. Imperfect consolidation of vertebrae demanded performing anterior spondylodesis in all 9 cases. Reconstructive operations with complete restoration of a canalís anatomic form and its lumen were made in patients with its marked posttraumatic stenosis. Surgical correction of persistent marked deformities of the spine was the most complicated type of interventions. The main stages of such operations were as follows: anterior and posterior mobilization, deformity correction and stabilization of the spine in a correct position by metal implants, anterior spondylodesis.
The analysis of long-term results of surgical treatment demonstrated its high efficacy. Good and excellent results were obtained in 179 cases (82.1%).