SURGICAL TREATMENT OF PATIENTS WITH THORACIC AND LUMBAR SPINE INJURIES

Abstract

The authors report the analysis of large clinical data (476 patients). Basing on its results practical recommendations to optimize surgical management of patients with acute thoracic and lumbar injuries are suggested. Decompressionstabilization surgery for spine-spinal cord injury is expedient during the first hours of admittance to the specialized department but only after bringing a patient out of shock to the condition of moderate severity and after salvage operation. First three days after trauma are the optimal terms for stabilizing surgery in patients with uncomplicated spine injuries. For severe multiple and concomitant injuries the surgeries only through lateral or posterior-lateral approaches are permissible, any broadening of surgical intervention caused increase in mortality. Choice of correction and stabilization technique should be based on the character of spine fracture, surgeon's skill and equipment facilities of a hospital. If surgeon's skill is high and modern sets of instruments and implants for spine stabilization are available, it is more preferable to use transpedicular or multihooked systems and anterior spinal instrumentation. Authors have not revealed reliable differences in application of bone autografts and majority of contemporary implants for reconstruction of vertebral bodies. However, it is the authors' opinion that implants of porous material and of hollow design combined with bone autoplasty are preferable for anterior spinal fusion. The outcomes of surgical treatment were followed for 1 to 10 years.