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Spinal Trauma Repair Strategies for Orthopaedic Surgeons
Ness M.G.
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Spinal trauma presents a collection of particular problems to the attending clinician. Traumatic injury of the vertebral column implies large forces and consequently, other concomitant non-orthopaedic, non-neurological injuries are often present. Furthermore, diagnosis of the neurological and orthopaedic injuries requires considerable multi-disciplinary knowledge and experience and frequently involves the use of costly diagnostic imaging. Surgical interventions are typically complex; prognoses often rather poor and convalescence typically lengthy and involved. Treatment costs can be prohibitive.
Spinal trauma resulting in vertebral fracture or luxation (VFL) almost always causes pain and neurologic dysfunction. The neurologic dysfunction is the result of contusion or compression of the spinal cord and adjacent nerves. Persisting compression, whether static or dynamic caused by spinal instability can exacerbate the neurologic injury through demyelination and axonal or neuronal destruction.
At the time of writing, there is effectively no potential for regenerating neural tissues. Consequently, therapeutic strategies are focussed exclusively on the preservation of function and potential in surviving neural tissues. That might involve surgical decompression or stabilization of the spine but implicit in that statement is the prevention of further injury.
Orthopaedic surgeons should resist the strong temptation to look past the neurologic patient to see just a “fixable” fracture. Vertebral column fractures and luxations are inherently stable due to the bone morphology, spinal biomechanics and specifically the large amount of adjacent “core” musculature. Surgeons must be aware that any surgical approach to the spine inevitably disrupts this stabilizing musculature and renders the spine inherently less stable and therefore more reliant on the implants placed. The potential to impair the neurologic prognosis in pursuit of an isolated fracture repair should not be under-estimated. [...]
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