Prevention of secondary damage to the spinal cord, indications for urgent surgery in terms of spinal cord decompression


 * secondary damage to the spinal cord – a series of biochemical events that lead to the expansion of the original lesion after the trauma,
 * primary changes – injury → in a few minutes – petechiae in the tissue, in an hour gray matter perfusion decreases, tissue acidosis occurs, in 4 h hemorrhagic necrosis already occurs,
 * reduction of blood flow causes edema, progresses longitudinally and radially, tightens the pia mater, and this leads to compression of small subpial vessels, which does not exactly add much → deterioration of microcirculation,
 * free radicals (VR) are formed and these cause further (secondary) damage,
 * the key substance limiting the occurrence of VR is methylprednisolone– we start the therapy 3 hours after the injury – initially a bolus of about 30 mg/kg weight, then after a 45-minute break we administer it continuously for 23 hours at a rate of 5.4 mg/h/kg,
 * the administration makes sense even after 8 hours after damage,
 * diagnosis - if damage to the spine is suspected - x-ray in two projections, CT aimed at the site of the lesion, MRI to clarify the diagnosis, exclusion of compression by a hernia or hematoma

Indications for urgent surgery in terms of spinal cord decompression

 * current methods of repositioning and stabilization of the spine usually also ensure the restoration of the patency of the spinal canal (and thus decompression of the spinal cord),
 * therefore, decompression laminectomies previously performed today are not indicated,
 * we resort to laminectomy (as a complement to repositioning and stabilization) when we need to revise the canal (remove fragments, protrusions, dura plastic, ...),
 * urgent decompression is necessary in all syndromes of partial spinal cord injury, especially in:
 * progression of neurological findings,
 * proven channel impassability,
 * proof of bone fragments, hematoma or disc,
 * in open wounds,
 * on the contrary, with symptoms of a transverse lesion lasting longer than 24 hours, emergency decompression usually does not improve the condition.

Care of patients with spinal cord injury

 * have a high susceptibility to the formation of pressure ulcers,
 * a long-term problem is bladder care,
 * in the stage of spinal shock, there is urinary retention - frequent catheterization is necessary (it has fewer complications than a permanent catheter),
 * when the micturition center is preserved (lesions above S2–S4) – practicing reflex automatic emptying,
 * the reflex is triggered by intramural ggl. in the wall of the bladder - by pressure,
 * often in the first days there is a decrease in GIT peristalsis, up to paralytic ileus,
 * in Th spine lesions – care for breathing.