SURGICAL TREATMENT OF PATIENTS WITH THORACIC AND LUMBAR SPINE INJURIES

The authors report the results of the analysis of a large body of clinical data (476 patients). Based on its results, practical recommendations for optimizing the surgical management of patients with acute thoracic and lumbar injuries are proposed. Decompression-stabilization surgery for spine-spinal cord injury is expedient during the first hours of admittance to a specialized department but only after bringing a patient out of shock to the condition of moderate severity and after the salvage surgery. First three days after trauma are the optimal terms for conducting stabilizing surgeries 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 increased the mortality. The choice of a correction and stabilization technique should be based on the character of spine fracture, surgeon’s skills and equipment facilities of a hospital. If surgeon’s qualification is high and modern sets of instruments and implants for spine stabilization are available, it is more preferable to use transpedicular or multihook systems and anterior spinal instrumentation. No reliable differences in application of bone autografts and the majority of contemporary implants for reconstruction of vertebral bodies have been revealed. However, the authors believe that implants made of porous materials and (or) having hollow design combined with bone autoplasty are preferable for anterior spinal fusion. The outcomes of surgical treatment were followed for 1 to 10 years.