Open AccessTREATMENT OF THORACIC AND LUMBAR SPINE AND SPINAL CORD INJURY IN CHILDREN
Author(s) -
Eduard Ulrikh,
Sergey Vissarionov,
Александр Юрьевич Мушкин
Publication year - 2006
Publication title -
hirurgiâ pozvonočnika
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.138
H-Index - 3
eISSN - 2313-1497
pISSN - 1810-8997
DOI - 10.14531/ss2006.1.13-19
Subject(s) - medicine , burst fracture , surgery , decompression , spinal canal , spinal cord , fixation (population genetics) , spinal cord injury , laminoplasty , laminectomy , population , environmental health , psychiatry
Objective. To assess results of surgical treatment and to develop an optimal management regiment of patients with spine and spinal cord injury. Material and methods. Twenty patients, age 9 to 17 years, with complicated unstable spinal injuries were operated on. Out of them 13patients had severe Frankel grades A, B, C neurological disorders, 7 patients – grades D and Er. Seventeen patients had burst fractures, one – seat-belt injury, and two – fracture-dislocations. Surgery was performed in the first hours following the trauma in 9 patients, within two weeks – in 9, and after 15 days – in two. Burst fractures with grades A, B, C were treated by simultaneous posterior reposition and fixation of the injured segment, and anterior decompression and fusion. Grade D and Er was treated initially by indirect posterior reduction and fixation of the involved segment. If neurological disorders still remained decompression and body fusion were performed. Posterior-lateral decompression and instrumental fixation were performed in cases of seat-belt injuries. Fracture-dislocation was treated by decompression laminoplasty, spinal canal revision, followed by posterior reposition and fixation. Results. Two patients with burst fractures and grade A neurological disorders have shown a regression to the grade D. Dynamics of neurological restoration to grades B and C was observed in 4patients. The patient with grade B has not shown any regression. A positive dynamics with motor function improvement was observed in 4 patients with grade C. Seven patients (6 with burst fractures, 1 with seat-belt trauma) with grade D and Er were operated on within first hours and day after the trauma. First stage of surgical treatment provided elimination of neurological deficit in 5 cases. Two patients with grade D required the second stage. Regression of neurological deficit was not achieved in patients with fracture-dislocations. Conclusion. Surgical treatment of patients with complicated spine and spinal cord injury should be performed within first 6–8 hours after the trauma.