Thoraco-lumbar spinal cord injury, clinical and imaging aspects, surgical treatment

Abstract

Introduction: Spinal cord injuries present a major problem worldwide by their increasing incidence, vital outcomes, by the disability and mortality that they produce, by the diagnostic difficulties and complexity of surgical procedures. In our country the incidence of spinal cord injury is 2 to 17.7% according to some local authors, the average age of damage being 39.4 years, mainly affecting males in the ratio of 4:1. In the framework of polytraumas, in the Republic of Moldova spinal cord injury occurs in 13-30% cases. Medullar impairment is 30%, with a disability of 95-98%. Lethality after spinal cord injuries is 34.4%. Methods: It is presented the analysis of clinical and anamnesis data, laboratory investigations and surgical treatment of 40 patients with lumbar spinal cord injury and thoraco-lumbar injury from the Republican Traumatology and Orthopedics Center. Purpose: To analyze the cases of thoraco-lumbar spinal cord injury studying the circumstances in which the trauma occurred, the lesions location, the persistent clinical signs, diagnostic and surgical method used, in base of observational records of the Department of vertrebrology of the Republican Traumatology and Orthopedics Center. Objectives: To elucidate the injury mechanisms of thoraco-lumbar spinal cord injury in examined patients; To assess the level of spinal lesion most often involved in toraco-lumbar spinal cord injury; To assess the degree of spinal cord damage and persistent neurological disorders following thoraco-lumbar spinal cord injury; Clinical results evaluation of surgical treatment used in thoraco-lumbar spinal cord injury. Results: The results obtained were: men were involved in 60% cases (n = 24) against women - 40% (n = 16), average age being 36.25 (± 2.35) years, with prevalence from rural areas. ThoracoTumbar spinal cord injury etiology was varied: fall from a height 50%, traffic accidents 22.5%, falls from one’s own height 10%, hit with objects in the lumbar region 10% and other causes 7.5%. The most affected anatomical level was thoraco-lumbar junction because of its anatomical features, Thl2-L2 vertebrae being affected in 70% (n = 28). L3-L5 vertebrae injuries have been less frequent - 27.5% (n = 11). Neurological damage in the study occurred in 37.5% cases of thoraco-lumbar SCI with the following consequences: monoparesis in 7.5% cases, 10% paraparesis, sphincter disturbances 10% and 5% radiculopathies. Surgical treatment was applied with the purpose of neural decompression, stabilization and fusion. By posterior access were made 87.5% (n = 35) of surgeries, by anterior access 7.5% (n = 3) and combined approach - 5% (n = 2). Conclusion: Thoraco-lumbar spinal cord injury is a serious affection of the spine, affecting working population at young age with predominant involvement of men from rural areas. Most frequent causes of spinal injury in thoraco-lumbar region are: catatraumas, road accidents, falls from own height these being responsible of the large number of spinal cord damage. The thoraco-lumbar junction was often subjected of lesion (70% cases). Predominant route of approach for the surgical treatment of SCI of thoraco-lumbar region was the posterior one.