Влияние сроков оперативного лечения детей с позвоночно-спинномозговой травмой на динамику неврологических нарушений

Objective. To assess the dynamics of neurological disorders in children with spine and spinal cord trauma in the thoracic and thoracolumbar spine, depending on the timing of surgery and the severity of spinal cord injury. Material and Methods . A total of 36 children aged 3 to 17 years were operated on for injuries to the thoracic spine and thoracolumbar junction accompanied by neurological deficit. Thoracic spine was damaged in 16 (44.4 %), thoracolumbar junction - in 20 (55.6 %) patients. Patients were divided into four groups based on time to surgery. Spinal bone lesions were assessed according to Magerl’s classification, and neurological disorders - to the ASIA scale. Results . Long-term results were followed for 5 years in all patients. Neurological function improvements in patients of Group 1 were observed in 1-2 days after surgery, Group 2 - in 2-3 days, Group 3 - in 5-7 days, and Group 4 - in 4-5 months. In Group 1 positive dynamics was observed as significant regression of sensory disorders, in Group 2 - as complete regression of neurological deficit in 2 patients, in Group 3 - as transition from C to D grade in 4 patients, from B to D grade in 2 patients, and 2 children had no regression. In Group 4 a regression of neurological disorders from B to C grade was observed in 6 children in 2-3 years, and 10 patients (A grade) had no improvement in neurological status. Conclusion . Complete and rapid recovery of neurological functions in children with complicated fractures of thoracic and thoracolumbar spine is observed after surgical treatment performed within the first 6-12 hours after injury, when neurological deficit is mainly caused by compression of the spinal cord and its elements, and secondary circulatory and pathological changes have not yet expressed.