Initial presurgical management of
spinal injuries with spinal cord damage includes cardiorespiratory
intensive care, a precise neurologic examination, and a complete radiological work-up with simple films, computed tomography, and also magnetic resonance imaging if there is a conflict between the imaging results and clinical findings. The structural lesion can then be staged, using a reproducible system with prognostic value for instability. Reduction,
decompression and stabilization are the three main objectives of orthopedic management. In our unit, reduction is achieved either with external maneuvers (
traction applied with cranial tongs for cervical
injuries, or placing long cushions under the patient with thoracolumbar injury) or by using internal, surgical techniques. Instead of waiting for
decompression by natural remodeling, surgeons should perform decompressive procedures. Surgical stabilization includes osteosynthesis and grafting, which permits more active patient care. The interval between injury and surgery is crucial. It should be as short as possible in case of severe instability or when the lesion cannot be reduced. We recommend the anterior approach to the lower cervical region. The posterior approach is simpler for urgent treatment of thoracolumbar lesions.
Spinal cord injuries in children pose two specific problems: that of spinal cord damage with no visible bony lesions; and that of subsequent spinal
deformities (
scoliosis, hypokyphosis, or hyperlordosis). The most common
spinal cord injuries in the elderly involve hyperextension in patients with cervical canal
stenosis. The incidence of spinal damage, with or without spinal cord involvement, is increasing Instability being rare in such cases, the primary objectives of surgery are usually
decompression and repair.