[Traumatic paraplegia: surgical measures]

Abstract

Reduction and fixation of unstable spine injuries in patients with neurological deficit are the prerequisites for early rehabilitation. Diagnostic procedures and surgery in patients with para-/tetraplegia must be performed urgently to avoid further neurological damage and ensure recovery. In parallel administration, high-dose steroids are initiated immediately after admission. In general, unstable spine fractures are reduced in a closed or open manner and stabilised. Bony fragments occluding the spinal channel are removed and, if necessary, the anterior column is reconstructed. Unstable fractures of the cervical spine are operated on either from the back and/or anteriorly, although the techniques used in the upper cervical spine are quite different from those used in the lower cervical spine. Instabilities of the thoraco-lumbar junction are reduced and stabilised via a dorsal and/or anterior-lateral approach (transthoracic or retroperitoneal). Exact preoperative planning is necessary due to the proximity of large vessels and organs, as well as the narrow space for positioning of the implants. With early operative stabilisation of the spine paretic/paralysed patients can be mobilised immediately and personal care is facilitated. In this article the operative techniques are described on the basis of examples chosen from 606 patients treated at the Division of Trauma Surgery, University Hospital of Zurich from 1992 to 1997. 119 patients (19%) were diagnosed with incomplete/complete para-/tetraplegia and 51 with various degrees of neurological deficit.