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Monday, 25.09.2023, 15:47
Main » Neurosurgery » Treatment of spinal cord injury 
Treatment of spinal cord injury

Treatment of spinal cord injury

Treatment of spinal cord injury is performed in a specialized trauma or neurosurgical hospital. If you suspect a spinal injury, even without the dysfunction of the spinal cord or its roots, the patient can not sit, move independently (turn around or walk), as primary uncomplicated trauma as a result of secondary displacement can be complicated.

Treatment of these patients begins even before admission to hospital. It lies in a careful spinal immobilization, that is creating the conditions under which excluded any movement in the spine. Most injuries of the cervical spine requires a so-called traction - stretching, resulting in the vertebrae are in place. General measures for spinal cord injuries are to monitor blood pressure, functions of the cardiovascular system and respiration.

Treatment of patients with high injury of the cervical spinal cord, combined with damage to the brain stem, in the majority of cases there is little chance of success. The methods of electrical stimulation to control the diaphragm breath in such cases. However, respiratory failure may be secondary, caused by disorder of stem functions are gradually developing as a result of circulatory disturbances and edema of the brain stem. In this case, the imposition of emergency tracheostomy are shown, followed by readjustment of the tracheobronchial tree using antiseptics, broncho-and mucolytics, and mechanical ventilation. Conducting and supporting artificial ventilation through a tracheal tube in patients with trauma of the cervical spinal cord is possible if there is no serious damage to the spinal cord are intact consciousness and hemodynamics.

Injury to the spine and spinal cord in a large part of the active cases require surgical treatment. Surgical intervention is necessary to eliminate all forms of compression of the brain and spinal deformity correction with subsequent stabilization. The indications for surgical treatment are: the presence in the spinal canal bone fragments and foreign bodies; perelomovyvihi spine, which caused compression of the spinal cord, the progression of spinal cord dysfunction due to edema and hemorrhachis; violation of patency of subarachnoid space. Contraindications - severe traumatic shock, especially when combined injuries, hemorrhagic shock, or serious violations of the vital functions.

The peculiarity of the late period of spinal cord injury is the appearance of a number of syndromes (pain, spastic, adhesions) and disorder of pelvic organs, which serve to eliminate the various microneurosurgical intervention. Thus, when pain functional neurosurgical operations are aimed at its various units: cordotomy, selective rhizotomy, commissurotomy, etc. In spastic syndrome positive, but short-term effect allows the use of hypothermia miotonolitikov and spinal cord surgery includes a number of surgical interventions - a longitudinal front mielotomiyu in segments L1-S1, bilateral longitudinal mielotomiyu etc.

Violation of the functions of urination caused by spinal cord injury, requires measures to the maximum discharge of the urinary tract. To this end, in the acute period of trauma, spinal and with the express traumatic shock is introduced into the urethra catheter. To prevent infection, and if it is available daily bladder was washed with a solution at a dilution of 1:5000 furatsilina with antibiotics.

In the absence of vesical reflex, if maintained electroexcitability bladder, shows a radio-frequency stimulating device implantation or transurethral electroresection bladder neck (the choice of the method associated with the results of urodynamic studies). In a second-contracted bladder, if the amount in the range of 10-20 ml, perform an operation of substitution of the bladder remains enteric graft (enteroplastika). To improve the innervation of the neurogenic bladder are also used demukozirovanny graft of small intestine (the section onkoy bowel without mucosa) and remuskulyarizatsiyu rectus (suturing of muscle tissue), some of microsurgical interventions on the nerves.

Pay attention to correct laying the patient. In the acute situation in the back at the turn of the cervical spine is essential. In order to prevent hyperextension of the knee ligaments at the joints recharged small rollers. To prevent sagging, they stop to rest against a hard surface. In order to avoid pressure sores under the heels, sacrum and neck cotton-gauze enclose the circles, the change of the patient should occur every 2 hours. In the patient on the side of his legs and arms should be bent. It should be wary of pressure ulcers in the large trochanter, knee joints, internal and external femoral condyle. Under them, enclose the bags of linseed or millet. The patient with spinal cord injury should be laid on a mattress protivoprolezhnevy.

In his absence - on a mattress of foam rubber or foam rubber, which should be placed under the shield. Make sure that the sheet was not going to fold, often turning the patient. When injuries of the cervical patient should not be put on the belly, and when injuries of thoracic and lumbar position in the abdomen is most profitable for the prevention of pressure sores. The skin should be cleaned daily with camphor spirit, and at once to wash dirty. For the prevention of inflammation of the prescribed daily total UV-irradiation. When you see redness, maceration process produce a damaged surface with an antiseptic solution (dioksidina, chlorhexidine, etc.) and the tanning solution of potassium permanganate. Long-term healing decubitus be surgery (plastic with the use of free skin autografts, moving musculocutaneous flap, excision of bedsores, etc.).

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