Complicated Spinal Injury Research Articles

Determination of the cost of treatment of patients with complicated spinal injury at the thoracic and lumbar levels in a multidisciplinary hospital

Introduction. The dramatic increase in the cost of treating patients with spinal cord injury is associated with the currently accepted active surgical tactics, as well as the use of new technologies, more expensive implants. Currently, a standardized method for calculating the costs of treating patients has not been developed, which may in the future lead to an incorrect assessment of the economic effectiveness of a particular treatment strategy.Aim. To assess the cost of diagnosis and treatment of patients with spinal injury of the thoracic and / or lumbar spine in a multidisciplinary emergency hospital.Materials and methods. The study was carried out in the Clinic of Emergency Neurosurgery of the N. V. Sklifosovsky Research Institute for Emergency Medicine, Moscow Healthcare Department during 2018–2021. A working group was formed from the doctors of the neurosurgical department. Further, a model of the therapeutic and diagnostic process was compiled with a reflection of all its characteristics: 1) compilation of a mo dified operogram, 2) transformation of the operogram into a technological map, 3) comparison of the obtained characteristics of the process of diagnosis and treatment of patients with spinal injury with actual data, correction.Results. The operogram included 136 steps of the process from the moment of admission of a patient with spinal injury to the emergency department to the moment of discharge (surgery is the 77th step), and also reflected the interactions of 38 participants in the process and took into account the variety of possible methods and tactics of treatment, taking into account the average frequency of their use. Based on the developed process model, a technological map was prepared, which combined quantitative parameters for all key resource characteristics of the process.Conclusions. Hospital costs for the treatment of a patient with isolated complicated spinal injury at the level of the thoracic and lumbar spine in a specialized hospital amount to 600,652.41 rubles. Out of the total amount of expenses, surgical intervention costs amount to 48.7 %.

ПРОФИЛАКТИКА СИНДРОМА ВЕГЕТАТИВНОЙ ГИПЕРРЕФЛЕКСИИ ПРИ ХИРУРГИЧЕСКОМ ЛЕЧЕНИИ ДЕКУБИТАЛЬНЫХ ЯЗВ У БОЛЬНЫХ С ПОСЛЕДСТВИЯМИ СПИНАЛЬНОЙ ТРАВМЫ

The work analyzed the anesthesiology of 132 patients with a complicated spinal injury, who underwent surgical treatment for decibital ulcers of various localization. The basic principles of surgical treatment, approaches to the choice of type and method of anesthesiology, measures to prevent the development of vegetative hyperreflexion syndrome during surgery and in the early postoperative period.

НЕВРОЛОГИЧЕСКИЕ НАРУШЕНИЯ У ДЕТЕЙ С ОСЛОЖНЕННЫМИ ПОВРЕЖДЕНИЯМИ ПОЗВОНОЧНИКА В ГРУДНОМ И ПОЯСНИЧНОМ ОТДЕЛАХ ДО И ПОСЛЕ ХИРУРГИЧЕСКОГО ЛЕЧЕНИЯ

Objective. To assess the dynamics of neurological disorders after surgical treatment in pediatric patients with complicated fractures of the thoracic and lumbar spine using ASIA scale. Material and Methods. Outcomes of surgical treatment in 32 children aged from 3 to 17 years with isolated injuries of the thoracic and lumbar spine accompanied by neurological disorders were analyzed. Type A3 fractures occurred in 50.0 %, type B in 6.3 %, and type C in 43.7 % of cases. Patients were divided into 2 groups: Group I included 12 patients with complete spinal cord injury, and Group II - 20 patients with incomplete injury. Results. In all patients, a vertebral-medullary conflict was eliminated and a rigid fixation of the damaged spinal motion segments was achieved. Voluntary movements in lower limbs of patients from Group I did not recover. Patients from Group II had significant decrease in paresis degree and sensitivity recovery in lower limbs: the ability of independent walking without aids and assistance was completely restored in 37.5 %, the ability to walk with one/two-sided assistive devices was achieved in 18.8 %, and significant improvement in lower limb support ability - in 6.3 % of cases. Conclusion. Surgical treatment of children with complicated spinal injury should include the elimination of vertebral-medullary conflict, complete reduction, and rigid stabilization with reconstruction of physiological profiles of injured spinal motion segments.

Endolumbal Nootropic−Ozone Therapy in Complex Treatment of Patients with Complicated Spinal Injury in Acute Period

Spinal trau ma occurs when there is damage to the spinal cord that results in a bruise, a partial tear, or a complete tear. Because the spinal cord is the central carrier of signals throughout the body, damage to the spinal cord can have serious consequences. During a 5 - year period (2005 – 2009), 39 patient’s spinal trauma – were treated in the Neurology department of RCSUMA. The patients were divided into two groups: The first group (main) included 25 patients, spinal injury complicated by different localization. The main criterion for evaluating the effectiveness of this method is clinic neurologic, liquor dynamic and liquorlogical: the emergence of positive neurological symptoms within two weeks after endolumbal nootropic-ozone therapy. 16 patients (64.0%) have after 2-3 times endolumbal nootropic-ozone therapy has appeared positive neurological symptoms as return of sensation the below level of damage and slight movement in the limbs. In 6 (24.0%) patients improved neurological symptoms occurred after 5-6 times the endolumbal nootropic-ozone therapy. In the control group from 5 (35.7%) patients after repeated carrying out endolumbal nootropic-ozone therapy in postoperative period there was not much positive neurological symptomatology and 9 (64.3%) even patients in postoperative period it remained the same. Received in the dynamics of the lumbar puncture data sanation and liquor dynamic tests have shown that improving the patency of liquor content spaces of spinal cord after 2-3 times a endolumbal nootropic-ozone therapy in 70.0% of cases, and data liqoulogical studies have shown that when endolumbal nootropic-ozone therapy the sanation of liquor was already in the first 3-4 days after injury, while patients control group has the full purifying liquor 8-10 per day. Professionally conducted decompression-stabilizing operations on the spine with the use of endolumbal nootropic-ozone therapy, patients with complicated spinal injury in acute period of injury significantly improves both the results of the treatment and nevrologic symptoms that reduces disability, and this positively affects the quality of life of these traumas.

Endolumbar nootropic-ozone therapy in multimodality treatment of patients with a complicated spinal injury at its acute period

Surgical treatment of 39 patients with complicated injuries of the vertebral column was analysed. In order to increase the efficacy of treatment in the main group of patients (25 observations), an endolumbar injection of Pyracetam and ozone during the postoperative period was used. The obtained data showed that after 2-3 endolumbar injections of Pyracetam and ozone within the postoperative period 16 (64.0 %) patients revealed development of sensitivity below the level of injured spinal cord segments and movements in the distal parts of their lower extremities. In 6 (24.0 %) patients neurological symptoms improved after 5-6 injections. In patients of the control group (14 observations), who did not undergo the above nootropic-ozone therapy, moderately positive neurological symptoms were found out only in 35.7 % of cases. In 64.3 % of cases their neurological symptoms remained on the same level despite decompressive-stabilizing operations made.

Surgical treatment of complicated spinal injury in the acute period

Analysis of surgical treatment of 193 patients with complicated injury of cervical, thoracic and lumbar spine was performed. Optimum time for surgery, approaches, operation stages as well as necessity of injured segments fixation are considered. In cervical spine injuries decompression, spondylodesis with autobone and CSLP (AO) plate fixation were performed. In thoracic and lumbar spine injuries decompressive laminectomy, revision, meningomyeloradiculosis when indicated, suturing of injured radicis with following transpedicular fixation using USS (AO) system were carried out. High efficacy of surgical treatment for complicated spine injuries is proved in availability of minimum time after injury, rational preoperative planning, adequate anesthesiologic provision, wide decompression, and accurate choice of implanted metal device.

Use of a universal external fixation device in the treatment of bedsores in patients with complicated spinal injury by skeletal suspension

In severe spinal injury with spinal cord injury, bedsores occur in 53-90% of patients. Being the entrance gate for infection, they contribute to the occurrence of sepsis, often leading to death.

Rheumatoid factors of the blood and cerebrospinal fluid in patients with a complicated spinal injury

The levels of rheumatoid factors (RF) of IgM-RF and IgG-RF classes were measured by enzyme immunoassay (EIA) in the sera of patients with spinal injuries. Analysis showed that 46% of patients with spinal injuries were seropositive for IgG-RF-and 40% for IgM-RF; no IgG-RF was detected in the cerebrospinal fluid (CSF), whereas the IgM-RF content was 37.6 μg/ml. Results of RF measurements in the sera make it possible to qualify the systemic involvement of the body in the late period of a spinal injury as a rheumatic disease. The findings point to the presence of independent mechanisms of immune control in the CSF.

Tactics of a neurosurgeon in the acute period of complicated spinal injury

A comprehensive examination of 207 patients with spinal and spinal cord injuries in the acute period of the disease was carried out. 120 patients were operated on during the first 2 days after admission to the hospital. 87 patients received conservative treatment. The regression of the neurological deficit and the results of treatment for the restoration of function were the best in the group of operated patients.