When developing an individual treatment plan for each patient, the main task is to provide the strictest rest for the damaged spine in the form of its complete immobilization in one way or another. It is extremely important to prevent secondary displacement of the vertebrae in the fracture area.
Strict fixation is especially necessary for fractures and dislocations in the cervical spine, in particular for fractures of the dentate process of the II cervical vertebra. For this purpose , a spinal traction system is used with the help of a Glisson loop or a special terminal for the skull. The cervical spine can be additionally fixed with a Schantz dressing.
In case of fractures in the thoracic and lumbar spine , fixation in a plaster bed with cotton pelots , as well as fixation in the bed with simultaneous stretching is indicated. In addition, a traction system using straps and with a roller under the fracture area is recommended.
A one-time reduction in -normal conditions is not safe and most authors are not recommended.
In some cases, especially with hemorrhage in the membranes, as it dissolves, a turn for the better occurs and paresis gradually disappears with only conservative treatment. In other cases, symptoms of increasing compression of the spinal cord are pronounced. Brain compression syndrome is a direct indication for surgery in the form of a laminectomy, the task of which is to detect and eliminate the cause of compression of the brain.
Partial spinal cord injury is also an indication for laminectomy. With complete damage to the tire brain, the operation is not shown and to no avail. C, rock for surgical intervention is determined in most patients in the first days after damage. In some cases, late laminectomy is also recommended, performed a few weeks or even months after the damage.
Careful care for patients with spinal cord injuries is of great importance: the prevention and treatment of pressure sores, especially in the sacral and calcaneal areas of the feet; fight against urinary tract infection.
Trophic disorders in the kidneys and mucous membrane of the bladder, paralytic disorders of the outflow of urine, its stagnation contribute to the rapid development of complications and the spread of infection. Following the onset of cystitis, pyelitis, pyelonephritis, nephritis develop, sometimes urosepsis , which poses the greatest threat to life.
The main therapeutic and preventive measure in the fight against uroinfection , in addition to the desire to restore the conductivity of the spinal cord by surgery, is the artificial excretion of urine. The methods for emptying the bladder in case of paralysis include temporary and prolonged catheterization, as well as urine diversion by constant drainage through the suprapubic fistula. Recently, in hospitals, the system of prolonged washing of the bladder with antiseptic solutions (according to Monroe) has been widely used.
Essentially important is the systematic conduct of therapeutic exercises, massage and a number of physiotherapeutic procedures.
The systematic use of baths and movements improves trophic tissue, as well as the general condition of the patient, stimulates his ability to active movements. It is necessary to prevent contractures of the extremities, in particular the feet, where equinus deformation often develops . The position of the feet at right angles to the lower leg when they rest in a box upholstered with felt prevents deformation. With already developing contractures, passive-active gymnastics, removable or non-removable twists, step plaster bandages are used.
At the end of inpatient treatment and consolidation of the fracture, it is recommended that the patient be referred to a mud resort for at least 2 months. More seriously ill patients need to be assigned special gymnastics to teach them how to walk, first with the help of the arena, and then with the help of crutches and sticks. Orthopedic devices and fixing corsets are sometimes prescribed.
Mud therapy with persistent use of functional therapy should be repeated for several seasons in a row.
The prognosis for many patients with complicated spinal injuries is serious, but not hopeless; with persistent and systematic treatment, good and satisfactory results can be achieved. However, it should be emphasized the extreme duration of the recovery process, which often lasts several years. Complete transverse injuries of the spinal cord, as a rule, lead to death.