Differentiated treatment in patients with traumatic vertebral canal stenosis at lower thoracic and lumbar levels

Инновационная медицина Кубани

I. V. Basankin¹  A. A. Afaunov²  A. V. Kuzmenko³ 

[1] Кубанский государственный медицинский университет Министерства здравоохранения РФ;Кубанский государственный медицинский университет Министерства здравоохранения РФ;Научно-исследовательский институт – Краевая клиническая больница № 1 им. проф. С.В. Очаповского Министерства здравоохранения Краснодарского края;

关键词: позвоночник;    травма;    стеноз;    декомпрессия;    лигаментотаксис;   

DOI  :  

来源: DOAJ

【 摘 要 】

Background. We tried to justify differential approach to perform dural sac decompression in cases with damaged lower thoracic and lumbar spine accompanied by traumatic vertebral canal stenosis.Material and Methods. We analyzed 264 adult patients with lower thoracic and lumbar spine injuries which were accompanied by traumatic vertebral canal stenosis. We included 170 patients in the main group and 94 patients in the control group. Immediate morphologival reasons of traumatic vertebral canal stenosis were examined. We defined 6 types of stenosis. In all cases we performed decompressive stabilizing operations with transpedicular fixation. In patients of the main group we preferred indirect repositioning decompression. Only in 47% patients we performed laminectomy. In the control group in cases with transpedicular fixation we performed decompressive laminectomy in 100%. At this we did not pay attention to possibilities of closed vertebral canal reformatting due to ligamentotaxis.Conclusion.1. Traumatic stenoses of the vertebral canal at the levels of lower thoracic and lumbar spine with equivalent quantitative spondylometric findings and clinical evidence may show quite different morphological reasons.2. In cases with transpedicular fixation potential possibility for dural sac repositioning decompression without laminectomy is defined by morphological causes of traumatic stenosis and timeline since the trauma onset.3. Repositioning decompression of the dural sac is most effective at single bone fragment of the traumatized vertebra posterior part or two gross bone fragments without any reversion, in terms up to 10 days from the trauma onset or at subluxation and luxation both in early and late terms.4. In 90 of 170 patients (52.9%) from the main group applying differentiated approach to dural sac decompression performance we could avoid laminectomy while performing decompressive stabilizing operations. And anterior decompression in cases with subtotal corporectomy was undertaken only in 48 patients (28,2%) which is 1,73 time more infrequent than in patients in the control group.

【 授权许可】

Unknown