Spine Injuries: Treatment

After complete crossing or degeneration, the nerve endings are not restored, and functional disturbances become permanent. The tissue of the compressed nerve can restore its function. Restoration of movements and sensitivity in the first week after the injury indicates a favorable prognosis. Dysfunction lasting more than 6 months after the injury is likely to become permanent.

[1], [2], [3], [4], [5], [6]

Emergency care for spine trauma

After stabilizing airway patency, respiration and circulation, the main goal is to prevent secondary damage to the spine or spinal cord. In case of unstable damage, flexion or extension of the spine can lead to a concussion or rupture of the spinal cord. In this regard, careless movement of the patient can cause paraplegia, tetraplegia and even death. A patient with suspected spinal trauma should be moved by a single unit and transported on a rigid flat shield or other hard surface, with additional stabilization of its position by lining without excessive pressure on the body parts. To immobilize the cervical spine, you need to use a fixing collar. Patients with lesions of the thoracic or lumbar spine can be transferred face down or lying on their backs. If the cervical spinal cord injuries that can make breathing difficult, the patient is transferred to the position on the back, closely monitoring the patency of his respiratory tract, avoiding compression of the thorax. It is advisable to send such patients to the trauma center.

[7], [8], [9], [10]

Scale of injuries due to spinal cord injury

Level	Violations
A = complete	The motor and sensory functions are lost, including the sacral segment S
B = incomplete	The motor function is lost, the sensitive function is stored below the level of injury, including the sacral segments S
C = incomplete	The motor function is stored below the level of injury, and in> 1 control muscle groups below the level of injury force <3 points
D = incomplete	The motor function is stored below the level of injury and, at least, in / control muscle groups below the level of injury, the force is 3 points
E = norm	Motor and sensory functions are not violated

Medical care is aimed at preventing hypoxia and arterial hypotension, each of which can enhance stress damage to the spinal cord. If the first cervical segments are damaged, intubation and respiratory support are usually necessary. During intubation, the cervical ligament is fixed.

The introduction of large doses of glucocorticoids, started 8 hours after injury, can improve the results of treatment. Methylprednisolone 30 mg / kg is administered intravenously for 1 hour, the next 23 hours, administered at a dose of 5.4 mg / kg per hour. Treatment of spine injuries includes rest, analgesics, muscle relaxants with or without surgical intervention before the resolution of edema and pain. Additional general medical measures for trauma are discussed in the relevant sections.

Unstable lesions are immobilized for a time until the healing of bones and soft tissues does not provide a sufficiently reliable comparison; sometimes there are indications for surgical comparison and internal fixation. With complete damage, the goal of surgical stabilization is to provide early activation. Restoration of a satisfactory neurological status below the level of damage is unlikely. In patients with incomplete spinal cord injury, on the contrary, after a decompression, a significant improvement in neurologic functions is possible. The optimal time for the operation of incomplete injuries of the spinal cord remains a matter of debate. Early performance of the operation (for example, in the first 24 hours) can have a more positive result and will allow earlier to start activation and rehabilitation.

Nursing care includes prevention of infections of the genitourinary tract and the lungs, as well as pressure sores [eg, turning paralyzed every 2 hours (using Stryker's frame if necessary)]. It is also necessary to prevent deep vein thrombosis. In still patients, the need to install a cavafilter should be considered.

Therapeutic measures of the late period

In some patients, spasticity can be effectively controlled medically. In the case of spasticity associated with spinal cord injury, baclofen 5 mg 3-4 times a day is usually administered (maximum 80 mg within the first 24 hours) and tizanidine 4 mg 3-4 times a day (maximum 36 mg during first 24 hours). In patients in whom oral administration has proved ineffective, the possibility of an intrathecal administration of 50-100 mg of baclofen 1 time per day can be considered.

Rehabilitation is necessary for patients to recover as completely as possible. Rehabilitation is best done in groups, combining physiotherapy, training skills and teaching methods to meet social and emotional needs. It is best if the rehabilitation team is coordinated by a physician with experience in performing physiotherapy and physical therapy (physiotherapist). The group usually includes nurses, social workers, nutritionists, psychologists, physiotherapists and occupational pathologists, recreational therapists and professional and technical consultants.

Physiotherapy focuses on exercises for restoring muscle strength and adapting to the use of auxiliary devices (walkers- "brackets", wheelchairs, etc.), necessary to increase mobility. They teach the skills of controlling spasticity of muscles, autonomic dysreflexia and neurologic pain. Restorative therapy is aimed at the restoration of subtle motor skills. Bladder and intestinal control programs teach toilet techniques, which may require periodic catheterization of the bladder. It is often necessary to work out the operating mode of the intestine on the basis of a fixed-time laxative appointment.

Vocational rehabilitation includes the assessment of both small and large motor skills, the cognitive ability of the patient, which is necessary to clarify the likelihood of adequate employment. Here, the need for auxiliary devices and the degree of modification of the potential workplace are determined. Recreational therapists use similar approaches to identify and facilitate the patient's occupation, for example hobbies, sports and other activities.

The goal of emotional assistance (psychotherapy) is to overcome the depersonalization and almost inevitable depression of a person who has lost control of his own body. Emotional support is fundamentally important for the success of all other components of rehabilitation and must be accompanied by maximum efforts to educate the patient and involve his family and friends.

Studies in the treatment of spine injuries are aimed at stimulating the regeneration of nerve tissue. These include injections of autologous, incubation macrophages; epidural prescribed BA-210, an experimental drug, possibly possessing both neuroprotective and stimulating nerve growth; and HP-184 for the treatment of chronic spinal cord injuries.