tailieunhanh - Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 86

Spinal Disorders: Fundamentals of Diagnosis and Treatment Part 86. Spinal disorders are among the most common medical conditions with significant impact on health related quality of life, use of health care resources and socio-economic costs. Spinal surgery is still one of the fastest growing areas in clinical medicine. | 848 Section Fractures Figure 10. Halo a b Correct positioning of the skull pins c halo vest. aspect of the head perimeter. Vest size is determined by measurement of chest circumference with a tape measure. The halo vest Fig. 10c seems to be the first choice for conservative treatment of unstable injuries of the upper cervical spine although pin track problems accurate fitting of the vest and a lack of patient compliance lead to clinical failures 165 . Because of these drawbacks the authors preference is a Minerva cast. Spinal cord injury frequently results from cervical fracture dislocation Spinal Cord Injuries Spinal cord injuries are frequently associated with traumatic cervical spine fractures and cervical facet dislocation injuries due to a displacement of fracture fragments or subluxation of one vertebra over another. Reduction of the deformity helps to restore the diameter of the bony canal and eliminates bony compression of the spinal cord. Theoretically early decompression of the spinal cord after injury may lead to improved neurological outcome. However indication and timing of surgical interventions in patients with complete and incomplete spinal cord injuries has been debated in the literature 6 . Yablon et al. 211 found that patients who underwent operative stabilization more frequently improved regarding neurological level than patients who were treated conservatively. In tetraplegic patients such improvement can be essential for quality of life. Cervical Spine Injuries Chapter 30 849 Role of Steroids in Acute Spinal Cord Injury The role of steroids in acute spinal cord injury is very controversial 35 122 . Although the use of corticosteroids can usually be considered safe in surgical patients 166 168 190 the potential side effects of high dose methylprednisolone such as infections 84 86 pancreatitis 100 myopathies 157 psychosis 194 and lactate acidosis in combination with intravenous adrenaline treatment 98 are important arguments against this .