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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
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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

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References

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