Neurosurgical aspects of treatment for patients with spinal cord injuries.

Abstract

• The first decision for the neurosurgeon after an injury to the spinal cord is whether any immediate neurosurgical maneuver is indicated. Neurological and roentgenographic examination determine whether fracture-dislocations need to be reduced, whether traction or laminectomy are necessary, and whether post-traumatic fragments of bone, intraspinal hematomas, or herniated intervertebral disks require attention. In many cases early laminectomy is actuatly the conservative course of action. Later problems for the neurosurgeon, from three months to several years after the injury, concern especially the intractable pain and spasticity that generally accompany paraplegia. Various procedures, including chordotomy, offer reasonable hope of relief of pain; alleviation of spasticity may be afforded by peripheral neurectomy, subarachnoid alcohol block, rhizotomy, or subtotal spinal chordectomy.