Assessment of efficiency of early decompression of the spinal cord in spinal injury based on morphological and statistical analysis
DOI:
https://doi.org/10.15587/2313-8416.2015.42015Ключевые слова:
spinal injury, secondary injury, spinal cord decompressionАннотация
Study of the morphogenesis processes in tissues of a damaged spinal cord during different periods of trauma, conducting statistical analysis of surgical treatment during acuity and early periods allow evaluating the effectiveness of early decompression. The aim of this research was to study the processes of morphogenesis in the damaged tissues of spinal cord and to evaluate the development of secondary changes due to prolonged compression.
Methods: A comparative morphological study of macro- and micro- preparations of 10 corpses. Causes of death were: an ascending edema of a spinal cord - 4, a brain injury - 1, a heavy polytrauma - 2, somatic complications (a thromboembolic disease, a pneumonia) - 3. Results of surgical treatment of 3 groups of patients in the acuity and early postoperative periods were analyzed. A comparative analysis of 180 observations of surgical treatment of patients with spinal cord and cauda equina trauma in the first 3 days, from 3 to 7 days and 7 days to 3 weeks was conducted. Analysis was performed on the American Spinal Injury Association (ASIA) scale. Correlation between morphological and statistical data is performed.
Results: On the basis of the morphological analysis, progression of secondary changes of a spinal cord during prolonged compression was determined, which become irreversible on the 7th-8th day. Secondary trauma is less frank after conducting an early decompression. Based on the dynamics analysis of the operations timing and the ASIA scale neurological data dynamics it was established that the effectiveness of surgical treatment in the first two groups (first 6 days) correspond to 70%, and in the third one (between 7 and 21 days) - 10%.
Conclusions: Primary spinal cord injury, after prolonged compression, is accompanied by progressive secondary changes and as a result, irreversible changes in the structure and function of the spinal cord. Morphological study helps to explain the results of the statistical analysis and to determine the most effective surgery timing as a whole. Early intervention may prevent the spread of secondary damage
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