Cases with Associated Trauma of the Spine and Spinal Cord: Diagnosis and Treatment

Grin ņ.*, Kaznacheev V.**, Nikolaev N.*, Ioffe Yu.*, Krilov V.*

* Sklifosovsky Research Institute of Emergency Care, Moscow, Russia;
** Moscow State Medical-Stomatologic University, Moscow, Russia

 

There were 820 cases with traumas of the spine and spinal cord (SSC), treated in neurosurgical departments of the Moscow hospitals in 2004. They were associated in 421 of them. The rate of postoperative mortality in cases with associated trauma of SSC was 22%.

The research goal was to improve treatment results in cases with associated trauma of SSC.

Material and Methods. There were 238 cases with such trauma, treated at the Sklifosovsky Research Institute of Emergency Care since 01.01.2000 up to 31.12.2004; 212 of them were operated. A diagnostic algorithm included general and neurological examinations; ultrasonic examination of pleural and abdominal cavities; X-ray examinations of the skull, pelvis, ribbons, injured extremities and all vertebral segments; CT of the spine at the level of trauma.

Results. Indications for urgent operation were as follows: compression of the spinal cord and its roots, aggravation of neurological symptoms and/or an unstable fracture of the vertebral column. Priority and urgency of operations were determined with taking into account such factors, as presence of this or that life-threatening trauma (the first priority), a possible loss of function of one or several organs (the second priority), no effect of delayed intervention on vital prognosis (the third priority). Shock, hemodynamic instability, coma, multiple injuries of ribbons with hemopneumothorax, anemia, heart contusion, renal and hepatic insufficiency, fat embolism, thromboembolism of a pulmonary artery, pneumonia, unfixed fractures of extremities were considered to be contraindications for urgent operation. Improvement of a neurological status was watched in 72% of cases. The rates of total and postoperative mortality in patients with associated trauma of SSC were 22% and 10% respectively.

Conclusion. The analysis of treatment results showed, that surgical tactics was conditioned by severity of associated injuries and a patientís condition before operation, as well as by dynamics of his state during intervention.