Thoracic Fracture-Dislocations Without Spinal Cord Injury - Two Cases Reports-

Acute traumatic central cord syndrome (ATCCS) is an incomplete spinal cord injury, originally described by Schneider in the early 1950s. The syndrome presents with disproportionate weakness of the upper extremities distally compared to the lower extremities, variable sensory loss, and decline in sphincter function. Although not unusual in fracture dislocations, ATCCS is typically observed in older patients with a background of degenerative spinal stenosis and suffering from a hyperextension injury of the cervical spine without instability. Many such patients to some extent recover clinically, and functional recovery might be helped with early spinal cord decompression. The timing of surgical decompression remains controversial.

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TREATMENT OF THORACIC AND LUMBAR SPINE AND SPINAL CORD INJURY IN CHILDREN

Hirurgiâ pozvonočnika ◽

10.14531/ss2006.1.13-19 ◽

2006 ◽

pp. 013-019

Author(s):

Eduard Vladimirovich Ulrikh ◽

Sergey Valentinivich Vissarionov ◽

Aleksandr Yuryevich Mushkin

Keyword(s):

Spinal Cord ◽

Spinal Cord Injury ◽

Surgical Treatment ◽

Neurological Deficit ◽

Neurological Disorders ◽

Seat Belt ◽

Fracture Dislocation ◽

Burst Fractures ◽

Cord Injury ◽

Fracture Dislocations

Objective. To assess results of surgical treatment and to develop an optimal management regiment of patients with spine and spinal cord injury. Material and methods. Twenty patients, age 9 to 17 years, with complicated unstable spinal injuries were operated on. Out of them 13patients had severe Frankel grades A, B, C neurological disorders, 7 patients – grades D and Er. Seventeen patients had burst fractures, one – seat-belt injury, and two – fracture-dislocations. Surgery was performed in the first hours following the trauma in 9 patients, within two weeks – in 9, and after 15 days – in two. Burst fractures with grades A, B, C were treated by simultaneous posterior reposition and fixation of the injured segment, and anterior decompression and fusion. Grade D and Er was treated initially by indirect posterior reduction and fixation of the involved segment. If neurological disorders still remained decompression and body fusion were performed. Posterior-lateral decompression and instrumental fixation were performed in cases of seat-belt injuries. Fracture-dislocation was treated by decompression laminoplasty, spinal canal revision, followed by posterior reposition and fixation. Results. Two patients with burst fractures and grade A neurological disorders have shown a regression to the grade D. Dynamics of neurological restoration to grades B and C was observed in 4patients. The patient with grade B has not shown any regression. A positive dynamics with motor function improvement was observed in 4 patients with grade C. Seven patients (6 with burst fractures, 1 with seat-belt trauma) with grade D and Er were operated on within first hours and day after the trauma. First stage of surgical treatment provided elimination of neurological deficit in 5 cases. Two patients with grade D required the second stage. Regression of neurological deficit was not achieved in patients with fracture-dislocations. Conclusion. Surgical treatment of patients with complicated spine and spinal cord injury should be performed within first 6–8 hours after the trauma.

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