TREATMENT FOR COMPLICATED AND UNCOMPLICATED SPINE INJURIES IN MULTITRAUMA PATIENTS

Objective. To determine treatment tactics for spine and spinal cord injuries in multitrauma patients. Material and Methods. 184 patients with spine and spinal cord injuries combined with multiple traumas were treated at Sklifosovsky Clinical and Research Institute for Emergency Medicine in 2000–2003, out of them 141 patients underwent surgical treatment. Diagnostic algorithm included general and neurologic examinations, ultrasound studies of the abdominal and pleural cavities, radiography of the skull, pelvic, ribs, injured extremities and all spine levels, and spine myelography and CT. Patients were examined by resuscitator, neurosurgeon, traumatologist and surgeon. Hemodynamic and arterial blood characteristics were monitored in critically ill patients. To assess the severity of multiple trauma the ISS scoring system was used. Results. Single-stage operation in the spine and bones of the skeleton was performed in 13 patients, first-stage spine surgery (preceding another intervention) – in 39 patients, second-stage spine surgery – in 24 patients, and 65 patients underwent a spine surgery alone. Neurologic status improved in 60 patients. Total lethality was 22 % and postoperative one – 14 %. Conclusion. Direct relation between surgery outcome and severity of multiple trauma was reveled. Application of upto- date transpedicular and laminar fixation techniques, and halo-apparatus provides the possibility to perform twostage surgery for complicated unstable vertebral fractures in patients with severe trauma.