[Traumatic lesions of the spinal cord. Management in the hospital: the orthopedic surgeon's point of view].
Initial presurgical management of spinal injuries with spinal cord damage includes cardiorespiratory intensive care, a precise neurologic examination, and a complete radiological work-up with simple films, computed tomography, and also magnetic resonance imaging if there is a conflict between the imaging results and clinical findings. The structural lesion can then be staged, using a reproducible system with prognostic value for instability. Reduction, decompression and stabilization are the three main objectives of orthopedic management. In our unit, reduction is achieved either with external maneuvers (traction applied with cranial tongs for cervical injuries, or placing long cushions under the patient with thoracolumbar injury) or by using internal, surgical techniques. Instead of waiting for decompression by natural remodeling, surgeons should perform decompressive procedures. Surgical stabilization includes osteosynthesis and grafting, which permits more active patient care. The interval between injury and surgery is crucial. It should be as short as possible in case of severe instability or when the lesion cannot be reduced. We recommend the anterior approach to the lower cervical region. The posterior approach is simpler for urgent treatment of thoracolumbar lesions. Spinal cord injuries in children pose two specific problems: that of spinal cord damage with no visible bony lesions; and that of subsequent spinal deformities (scoliosis, hypokyphosis, or hyperlordosis). The most common spinal cord injuries in the elderly involve hyperextension in patients with cervical canal stenosis. The incidence of spinal damage, with or without spinal cord involvement, is increasing Instability being rare in such cases, the primary objectives of surgery are usually decompression and repair.
Vital
Jean-Marc
JM
Unité de pathologie rachidienne, chirurgie orthopédique et réparatrice. Groupe hospitalier Pellegrin, place Amélie Raba-Léon, 33076 Bordeaux cedex.
D019299:Decompression, Surgical; D006801:Humans; D019637:Orthopedic Procedures; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000628:therapy*; D014143:Traction