Thoracolumbar spinal cord injury : management, techniques, timing

Jug, Marko (author), Komadina, Radko (author), Wendt, Klaus (author), Pape, Hans-Christoph (author), Bloemers, Frank (author), Nau, Christoph (author)

Acute traumatic spinal cord injury (tSCI) is a complex and heterogeneous injury, where the level of injury, injury severity, duration and degree of spinal cord compression, and blood pressure management seem to influence neurologic outcome. Although data in the literature seem to be inconsistent regarding the effectiveness of surgical decompression and spinal fixation in patients with thoracic and thoracolumbar tSCI, some single-center studies suggest that early surgical decompression may lead to a superior neurologic outcome, especially in patients with incomplete tSCI, suggesting surgical decompression to be performed as soon as possible. However, high energy injuries, especially to the upper thoracic levels, may be too severe to be influenced by surgical decompression, which may represent a critical second hit for the polytraumatized patient. Therefore, the surgeon first needs to critically evaluate the potential for neurologic recovery in each patient before determining the ideal timing of surgery. Circulatory stabilization must be achieved before surgical intervention, and minimally invasive procedures should be preferred. Invasive blood pressure monitoring should be started on admission, and maintenance of a MAP between 85 and 90 mmHg is recommended for a duration of 5–7 days, with special attention to the prevention of hypoxia, fever, acidosis and deep venous thrombosis. The role of a 24-hour infusion of high-dose MPSS is still controversial, but it may be offered at the discretion of the treating surgeon to adult patients within 8 h of acute tSCI as a treatment option, especially in the case of very early decompression or incomplete tSCI.

• Language: English
• Keywords: spinal cord injury, thoracic spine, thoracolumbar spine, management, timing, decompression, therapy
• Work type: Article
• Typology: 1.02 - Review Article
• Organization: MF - Faculty of Medicine
• Publication status: Published
• Publication version: Version of Record
• Year: 2024
• Number of pages: Str. 1969-1975
• Numbering: Vol. 50, iss. 5
• PID: 20.500.12556/RUL-165332
• UDC: 612.83:616-001
• ISSN on article: 1863-9941
• DOI: 10.1007/s00068-024-02595-8
• COBISS.SI-ID: 217227523
• Publication date in RUL: 02.12.2024

Record is a part of a journal

• Title: European journal of trauma and emergency surgery
• Shortened title: Eur. j. trauma emerg. surg.
• Publisher: Springer Nature
• ISSN: 1863-9941
• COBISS.SI-ID: 513665817

Licences

• License: CC BY 4.0, Creative Commons Attribution 4.0 International
• Link: http://creativecommons.org/licenses/by/4.0/
• Description: This is the standard Creative Commons license that gives others maximum freedom to do what they want with the work as long as they credit the author.

Secondary language

• Language: Slovenian
• Keywords: poškodbe hrbtenjače, terapija