Traumatic para-/tetraplegia: surgical treatment

Reduction and fixation of unstable spine injuries in patients with neurolog ical deficit are the prerequisites fur early rehabilitation. Diagnostic pro cedures and surgery in patients with para-/tetraplegia must be performed ur gently to avoid further neurological damage and ensure recovery. In paralle l administration, high-dose steroids are initiated immediately after admiss ion. In general, unstable spine fractures are reduced in a closed or open manner and stabilised. Bony fragments occluding the spinal channel are removed an d, if necessary, the anterior column is reconstructed. Unstable fractures o f thr cervical spine are operated on either from the back and/or anteriorly , although the techniques used in the upper cervical spine are quite differ ent from those used in the lower cervical spine. Instabilities of the thoraco-lumbar junction are reduced and stabilised via a dorsal and/or anterior-lateral approach (transthoracic or retroperitonea l). Exact preoperative planning is necessary due to the proximity of large vessels and organs, as well as the narrow space for positioning of the impl ants. With early operative stabilisation of the spine paretic/paralysed pat ients can be mobilised immediately and personal care is facilitated. In thi s article the operative techniques are described on the basis of examples c hosen from 606 patients treated at the Division of Trauma Surgery, Universi ty Hospital of Zurich from 1992 to 1997 119 patients (19%) were diagnosed w ith incomplete/complete para-/tetraplegia and 51 with various degrees of ne urological deficit.