Patients with Injuries of the Spine and Spinal Cord: Tactics of Surgical Treatment in Associated Trauma

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

(Sklifosovsky Research Institute of Emergency care, Moscow)

The goal of the study was to determine tactics of treatment of spine and spinal cord injuries in associated trauma, watched in almost 50% of cases.

Materials and Methods. There were 127 patients with associated spine and spinal cord trauma, treated in the Sklifosovsky Research Institute of Emergency Care from 01.01.2000 up to 31.12.2002; 113 of them demanded interventions on the spine and spinal cord. Operations were performed in 98 cases. A diagnostic algorithm included general and neurological examinations, rentgenography, myelography and CT of the spine. Operations in urgent, delayed or intermediate periods were made in 71 and 27 cases respectively. Modern fixing devices were used in 61 patients.

Results. Surgical tactics was chosen after estimation of a general state and an injury character. Compression of the spinal cord and its roots, an unstable fracture were indications for an urgent operation. An unstable fracture without neurological disorders allowed to perform operation after complete stabilization of a patientís state. Treatment tactics and an operation volume were chosen with taking into account associated pathology. An extremely severe state (unstable hemodynamics, coma, anemia, renal or hepatic insufficiency, fat embolism, pneumonia, unfixed fractures of extremities) was a contraindication for operation on the spine.

Fatal outcomes (18.3%) were conditioned by severe thoracic trauma with lung or heat contusion, factures of pelvic bones, severe craniocerebral trauma and concomitant pyo-septic complications.

Conclusion. One-stage or consecutive operations on the spine and spinal cord with its fixing within 72 hours permit to ensure early activity of patients and, thus, to reduce mortality, caused by pyo-septic complications and embolism.