Casualties with Acute Trauma of the Spine and Spinal Cord of Thoracic and Lumbar Localization: Modern Principles of Surgery

Dulaev ., Orlov V., Nadulich ., Teremshonok ., Dulaeva N.

Medicomilitary Academy, Saint Petersburg, Russia

 

The experience of surgical treatment of casualties with acute trauma of the spine and spinal cord, localized at thoracic and lumbar levels, was summarized (512 cases). Traumas of thoracic, transitional and lumbar segments were watched in 97 (18.9%), 352 (68.8%) and 63 (12.3%) cases respectively. Distribution according to the ASIA scale was as follows: A - 14.5% (74 cases), B - 19.9% (102), C - 26.7% (137), D - 22.1% (113), E - 16.8% (86). Casualties with severe associated trauma (157 cases or 30.7%) were operated after improving their state. Operations on the spine were performed, using a posterior approach. The spine was corrected and stabilized by metal implants. As for cases with isolated or moderate associated trauma, surgical tactics was conditioned by a character of injury of the spine and spinal cord. The main principle was achieving goals of surgical treatment during one and the same operation. Decompressive-stabilizing and reconstructive operations were performed on the spine. Approaches were as follows: anterior - 119 out of 355 cases (33.5%), posterior - 162 cases (45.6%), combined anterior-posterior - 74 cases (20.1%). Partial and complete regression of neurological symptoms was observed in 248 (65.4%) and 52 (13.7%) cases respectively. There was no neurological dynamics in 75 patients (19.8%). Postoperative aggravation of neurological deficit was typical of 4 cases (1.1%). Complete and partial correction of spine deformities was achieved in 292 (77.0%) and 87 (23.0%) cases respectively. There were 32 patients (8.4%), who complained of vertebrogenic pain syndrome.