The Effect of Suboptimal Surgical Treatment of Spinal Fractures on the Course of Spinal Cord Injury

Česká verzia

Authors: R. Lukáš ¹; J. Štulík ²; J. Šrám ¹; J. Pazour ¹; J. Kříž ²; P. Nesnídal ³
Authors place of work: Traumacentrum, Krajská nemocnice Liberec, a. s. ¹; Spinální jednotka při Klinice rehabilitace a tělovýchovného lékařství 2. LF UK a FN v Motole, Praha ²; Spondylochirurgické oddělení, FN v Motole, Praha ³
Published in the journal: Cesk Slov Neurol N 2014; 77/110(6): 734-740
Category: Short Communication

Summary

Introduction:
Right surgical strategy, optimal timing and correct surgical technique are crucial for the quality of treatment of spinal fractures associated with neurological deficit. Failure of any of these parts of treatment has an immensely negative effect on subsequent patient care. In many cases, the quality of technical performance of the surgery is controversial. It is desirable to improve the use of spinal implants to achieve undisturbed course of subacute and chronic phases of treatment.

Material and methods:
Retrospective analysis of the quality of primary surgical treatment of patients with posttraumatic spinal cord injury treated at the Spinal Unit of the Regional Hospital Liberec between 2003 and 2012 and at the Spinal Unit of the University Hospital Motol in Prague between 2004 and 2012.

Results:
Incorrect surgical treatment was delivered in 191 of 775 cases (24.6%). Wrong fracture reduction was preformed in 111 cases (58.1%). Incorrect pedicle screw insertion was found in 78 cases, followed by insufficient decompression of the spinal channel in 52 cases. A revision surgery with complete reinstrumentation was required in 85 patients (44.5%). We identified no development in the number of suboptimally treated patients over the analyzed years. The length of hospital stay in suboptimally treated patients was prolonged by the mean of 9.58 days.

Conclusion:
The authors recommend strict compliance with the surgical technique and rigorous post-operative X-ray follow ups. This field could further be improved with high-quality spinal surgery educational system.

Key words:
spinal cord injury – spinal cord decompression – spinal fracture reduction – spine stabilization

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE “uniform requirements” for biomedical papers.

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