Decompresive-reconstructive surgery in treatment of vertebro-medular traumatism consequences

Abstract

Corresponding authors’ dates on vertebro-medular traumatisms represent from 10% to 48% of vertebral column disease. Vertebro-medular traumatism consequences, which underline in clinical evolution a traumatic disease period, restore partial in time, spinal functions reappear in dependence of lesion severity or worsening neurological symptoms, progressing in following traumatic spinal deformities, vicious bone callus formation, etc. Currently, to improve patient clinical outcomes with vertebro-medular traumatism consequences is practicing a rational combination of decompresive reconstructive surgical methods, with or without stabilization, and complex conservative treatment. The aim of the work was to research in dynamic development and results analysis of surgical treatment at patients with severe posttraumatic spinal vertebra disease. Was analyzed the records of observation and dynamic assessment in clinical development to 24 patients with spinal vertebra disease and severe posttraumatic spinal vertebra disease, surgical intervention in Central Clinical Military Hospital during 2003-2009. Females - 4(16, 66%) and males - 20(83, 33%). Patient’s age constituted from 17 to 54 years, with average age of 35±1, 2 years old. From anterior side was performed surgical interventions to 4(16, 66%), from posterior side 20(83, 33%). Surgical interventions were made to patients from the traumatism within 8 months until 8 years, in average 2,4±0,4 years. Most patients 20(83,33%) from 24, whom were performed surgical reinterventions, were unable to work. Disabled Grade I -17(70,83%), of them 13 (76.47%) - clinical manifestation of inferior paraplegia with pelvic organs functions disorder, but 4(23,53%) patients - deep inferior paraparesis. Disabled Grade II - 2(8,33%) patients with posttraumatic myelopathy with static disorder and movement. Disabled Grade III -just 1 patient (4,1%) - posttraumatic discirculatory caudopathy and sphincter disturbance. Four cases (16,66%) - had no neurological disorders. Surgical intervention’s time ranged within the 125 minutes until 180 minutes, with average time 155±6,8 minutes, intraoperator hemorrhage average 705±10,1 ml. Duration of hospitalization was within 14 until 24 days, in average 19±1,4 days. In all cases was obtained partial neurological regress of neurological symptoms. The improvement of the Vertebral algic syndrome, significantly increased patient’s life quality (locomotion, autodeservation). Conclusion: 1. Surgical interventions applied in posttraumatic deformities of the spine with severe neurological disturbanses are one of the most dificult method, influenced by high rise of spinal traumatization, wound depth, long period of intervention; 2. Compression of vertebral deformities, fracture-luxation with spinal compression needs to make laminectomy or hemilaminectomy, not just at injury level, but also with partial rezecation of upper vertebral lamina.