Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-7479d7b7d-68ccn Total loading time: 0 Render date: 2024-07-10T23:20:08.074Z Has data issue: false hasContentIssue false

13 - Surgical Considerations for Spinal Cord Trauma

Published online by Cambridge University Press:  18 January 2010

By
Timothy Moore
Edited by
Charles E. Smith
Timothy Moore
Affiliation:
Department of Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
Charles E. Smith
Affiliation:
Case Western Reserve University, Ohio
Get access

Summary

Objectives

  1. Differentiate between a complete and incomplete spinal cord injury.

  2. Describe the clinical presentation of complete and incomplete spinal cord syndromes.

  3. State the two major considerations for surgical treatment of spinal cord injuries.

  4. Recognize unique surgical considerations in high cervical spinal cord injuries and unstable thoracic injuries.

SUMMARY

Surgery has greatly influenced the outcome of acute spinal cord injuries. Surgery involves decompression and stabilization to impart a stable motion segment while protecting the neurologic elements from further injury. Controversy exists concerning the role of corticosteroids and timing of surgery in acute spinal cord injuries. There is a need for a reproducible classification system to describe and dictate treatment for these injuries.

INTRODUCTION

Spinal cord injury (SCI) is a devastating event for the patient and society. There are approximately 200,000 Americans with SCI. A large percentage of these injuries involve males aged 20–40 years. The cost to society in maintaining care and quality of life is difficult to calculate.

Surgical intervention has made a significant impact on outcome with these injuries. The development of improved spinal instrumentation has allowed surgeons to approach the spine from 360 degrees. Varied approaches allow decompression of the neurologic elements and the ability to impart a stable spinal segment that improves mobilization and rehabilitation.

The role of surgery in spinal cord injury continues to evolve. A multidisciplinary approach is necessary to optimize outcome in spinal cord injuries. The orthopedic or neurologic surgeon remains a key component in the treatment of the patient with an acute traumatic event.

Type
Chapter
Information
Trauma Anesthesia , pp. 202 - 212
Publisher: Cambridge University Press
Print publication year: 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Eck, JC, Nachtigall, D, Humphreys, SC, Hodges, SD.Questionnaire survey of spine surgeons on the use of methylprednisolone for acute spinal cord injury. Spine 2006; 31(9): E250–3.CrossRefGoogle Scholar
Kubeck, JP, Merola, A, Mathur, S, Brkaric, M, Majid, K, Shanti, N, Caruso, S, Yuan, S, Lowe, T, Dwyer, A, Haher, T, O'Brien, M.End organ effects of high-dose human equivalent methylprednisolone in a spinal cord injury rat model. Spine 2006; 31(3): 257–61.CrossRefGoogle Scholar
Sayer, FT, Kronvall, E, Nilsson, OG.Methylprednisolone treatment in acute spinal cord injury: The myth challenged through a structured analysis of published literature (Review). Spine J 2006; 6(3): 335–43.CrossRefGoogle Scholar
Shields, CB, Zhang, YP, Shields, LB, Han, Y, Burke, DA, Mayer, NW.The therapeutic window for spinal cord decompression in a rat spinal cord injury model. J Neurosurg Spine 2005; 3(4): 302–7.CrossRefGoogle Scholar
Carlson, GD, Minato, Y, Okada, A, Gorden, CD, Warden, KE, Barbeau, JM, Biro, CL, Bahnuik, E, Bohlman, HH, Lamanna, JC.Early time-dependent decompression for spinal cord injury: Vascular mechanisms of recovery. J Neurotrauma 1997; 14(12): 951–62.CrossRefGoogle Scholar
Vaccaro, AR, Daugherty, RJ, Sheehan, TP, Dante, SJ, Cotler, JM, Balderston, RA, Herbison, GJ, Northrup, BE.Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine 1997; 22(22): 2609–13.CrossRefGoogle ScholarPubMed
McKinley, W, Meade, MA, Kirshblum, S, Barnard, B.Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury. Arch Physical Med Rehabil 2004; 85(11): 1818–25.CrossRefGoogle ScholarPubMed
Ball, JR, Sekhon, LH. Timing of decompression and fixation after spinal cord injury – when is surgery optimal? (Review). Crit Care Resuscit 2006; 8(1): 56–63.Google Scholar
Fehlings, MG, Perrin, RG.The role and timing of early decompression for cervical spinal cord injury: Update with a review of recent clinical evidence (Review). Injury 2005; 36(Suppl 2): B13–26.CrossRefGoogle Scholar
Guest, J, Eleraky, MA, Apostolides, PJ, Dickman, CA, Sonntag, VK.Traumatic central cord syndrome: Results of surgical management. J Neurosurg 2002; 97(1 Suppl): 25–32.Google ScholarPubMed
Kishan, S, Vives, MJ, Reiter, MF.Timing of surgery following spinal cord injury (Review). J Spinal Cord Med 2005; 28(1): 11–9.CrossRefGoogle Scholar
Anderson, PA, Bohlman, HH.Anterior decompression and arthrodesis of the cervical spine: Long-term motor improvement. Part II: Improvement in complete traumatic quadriplegia. J Bone Joint Surg 1992; 74(5): 683–92.CrossRefGoogle ScholarPubMed
Bohlman, HH, Anderson, PA.Anterior decompression and arthrodesis of the cervical spine: Long-term motor improvement. Part I: Improvement in incomplete traumatic quadriparesis. Bone Joint Surg 1992; 74(5): 671–82.CrossRefGoogle ScholarPubMed
Bohlman, HH, Kirkpatrick, JS, Delamarter, RB, Leventhal, M.Anterior decompression for late pain and paralysis after fractures of the thoracolumbar spine. Clin Orthopaedi Relat Res 1994; 300: 24–9.Google Scholar
O'Keeffe, T, Goldman, RK, Mayberry, JC, Rehm, CG, Hart, RA. Tracheostomy after anterior cervical spine fixation. J Trauma-Injury Infect Crit Care 2004; 57(4): 855–60.CrossRefGoogle ScholarPubMed
Vaccaro, AR, Lehman, RA Jr, Hurlbert, RJ, Anderson, PA, Harris, M, Hedlund, R, Harrop, J, Dvorak, M, Wood, K, Fehlings, MG, Fisher, C, Zeiller, SC, Anderson, DG, Bono, CM, Stock, GH, Brown, AK, Kuklo, T, Oner, FC.A new classification of thoracolumbar injuries: The importance of injury morphology, the integrity of the posterior ligamentous complex, and neurologic status. Spine 2005; 30(20): 2325–33.CrossRefGoogle ScholarPubMed
Vaccaro, AR, Lim, MR, Hurlbert, RJ, Lehman, RA Jr, Harrop, J, Fisher, DC, Dvorak, M, Anderson, DG, Zeiller, SC, Lee, JY, Fehlings, MG, Oner, FC, Spine Trauma Study Group. Surgical decision making for unstable thoracolumbar spine injuries: Results of a consensus panel review by the Spine Trauma Study Group. J Spinal Disord Tech 2006; 19(1): 1–10.CrossRefGoogle Scholar
Brodke, DS, Anderson, PA, Newell, DW, Grady, MS, Chapman, JR.Comparison of anterior and posterior approaches in cervical spinal cord injuries. J Spinal Disord Tech 2003; 16(3): 229–35.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure coreplatform@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×