Neural Injury and Recovery of the Thoracolumbar Spine Fractures.
10.4184/jkss.2001.8.3.413
- Author:
Dae Moo SHIM
1
;
Tae Kyun KIM
;
Ha Heon SONG
;
Dae Ho HA
;
Kyeong Jin KIM
Author Information
1. Department of Orthopaedic Surgery, Wonkwnag University Hospital, Iksan, Korea. osshim@wonkwang.ac.kr
- Publication Type:Review
- Keywords:
Thoracolumbar spine fracture;
Neural injury and recovery
- MeSH:
Calcium;
Cause of Death;
Classification;
Glutamic Acid;
Humans;
Kyphosis;
Lipid Peroxidation;
Methylprednisolone;
Naloxone;
Neurologic Examination;
Shock;
Spinal Cord;
Spine*;
Urinary Bladder
- From:Journal of Korean Society of Spine Surgery
2001;8(3):413-418
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
1. Evaluation of the Neural Injury For evaluation of neural injury from the thoracolumbar spine fracture, we should know the type and extent of injury. In case of the complete Spinal Cord Injury( SCI - Frankel classification A), they will not only lose the spinal cord function permanently distal to the injury site, but also show the probability 0~9% from Frankel A to D or E. But in case of the incomplete SCI, they will show sacral sparing and some kind of function will be recovered. The anticipation of recovery from the SCI depend on the results of neurologic examination after the spinal shock. If they have motor sparing, 86% of patients show the recovery of motor function during the first 6 month. The factor that influence to neurologic recovery are the initial kyphosis angle and canal compromising pattern, and do not influenced by treatmet methods. 2. The Factor of the Neural Injury Recovery 1) Conservative treatment in acute stage The inital pathophysiology of SCI is the mechanical injury, but secondary injury will be occur by impairment of blood supply and biochemical alteration, formation of free radial, release of glutamic acid, calcium influx, lipid peroxidation. Immediate methylprednisolone could minimize the spinal cord inury during the first 8 hours, and other GM-1 ganglioside, naloxone, TRH, spinal cord cooling, hyperbaric theraphy will be helpful. 2) Surgical treatment The factor influence the recovery of SCI (1) time interval injury to operation, (2)decompression of neural element, (3) reduction of fractured fragment. 3) Management of the Residual chronic stage Most common cause of death in SCI is urinary complication. We always should consider the improvement bladder function in SCI and the maintenance of low bladder pressure and feel free a bladder symptom.
