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

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  • 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[edit | edit source]

  • 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[edit | edit source]

  • 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.

Links[edit | edit source]

External links[edit | edit source]

Source[edit | edit source]

References[edit | edit source]

  • ZEMAN, Miroslav. special surgery. 2. edition. Galén, 2004. 575 pp. ISBN 80-7262-260-9.