Treatment of spinal and spinal cord injuries

By | May 21, 2020

Treatment of a patient who has received (even presumably) a spinal injury, as well as with suspected spinal cord injury, begins at the time of his discovery and even before his delivery to the hospital. The first necessary measure is the immobilization of the spine along its entire length. It is preferable to transport the injured to the neurosurgery department or a multidisciplinary department with the possibility of treating spinal patients.

In many cases, spinal cord and spinal cord injuries require surgical intervention. The specialist makes the decision on the basis of the severity of neurological symptoms. The operation, if necessary, is carried out in the shortest possible time, because after 6-8 hours after the fact of squeezing the spinal cord and the vessels ensuring its work, the results of ischemic changes can be irreversible. For this reason, all contraindications to surgical intervention present at the time of patient’s hospitalization are eliminated as part of intensive care. Such, as a rule, includes optimization of the respiratory and cardiovascular systems, indicators of homeostasis from the point of view of biochemistry, elimination (partially or, if possible, complete) of cerebral edema, infection prevention, etc. The operation may consist in the removal, prosthetics or correction of the position (reduction, decompression, reclamation ) of the vertebrae, restoration of the integrity of damaged organs and other actions that provide the best possible connection between the spine and the spinal cord.

If the injury does not require surgical intervention, the treatment consists in fixing the spine in a natural position (with previous reduction, if necessary) and stimulating the processes of tissue regeneration, nerve endings and the functioning of organs whose work was impaired due to the injury itself or its complications. The complex of therapeutic measures often includes the development of muscles around the damaged section, thermal procedures and massage, in more complex cases we are talking about immobilization of the spine in the affected areas, traction. The result of treatment determines the complex of rehabilitation measures.

Over the past decade and a half, there has been a tendency to move from conservative methods of treating hyperextension injury to the cervical spine (immobilization of the cervical-occipital region with a dressing followed by physiotherapy, applying a thoracocranial dressing, if indicated, stretching) to surgical intervention in cases where there is reason to believe that the influence of factors causing spinal cord compression.

Caring for patients with injuries of the spine and spinal cord is very difficult for staff, especially in the absence of regression of severe neurological disorders.

One of the most frequent and threatening complications of spinal cord injury is impaired bladder function.

For urgent emptying of the bladder, three methods are used:

periodic or continuous catheterization;

manual emptying of the bladder;

bubble puncture.

For the removal of urine from the bladder for a long time, two methods are used:

Monroe drainage using tidal drainage;

suprapubic cystostomy .

Monroe drainage consists in periodically introducing into the bladder a weak antiseptic solution or liquid dissolving the urinary salts, removing it from the bladder using the system and “breaking” the siphon after emptying the bladder. Clinical observations show that the Monroe system does not completely prevent the infection of the urinary tract, but in comparison with other methods it delays its development, reduces its manifestations and ensures the restoration of urination according to the so-called automatic type. In cases where there is reason to assume a prolonged violation of the function of urination, the method of applying a suprapubic fistula is used.

The main reason for the occurrence and development of pressure sores in areas where innervation is disturbed due to spinal cord injury is the high sensitivity of dystrophic tissues to mechanical and infectious influences. However, in places not exposed to pressure, bedsores never occur with any severity of damage to the spinal cord. In the treatment of pressure sores, it is important to create conditions that prevent the difficulties of lymph and blood circulation in the affected tissues and stimulate these processes. For this purpose, various ointment dressings (which sometimes include antibiotics), UFO ( erythema doses), scab removal , and excision of necrotic tissues are used. With the development of deep bedsores, wound refreshment, phased excision of necrotic tissues with early or late skin grafting is recommended , and with osteomyelitis – removal of the underlying bone.

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