REVISTA DE ENFERMERÍA 

8. INDICACIONES QUIRÚRGICAS

Los pacientes con trauma espinal pueden tener indicación quirúrgica en dos situaciones: 1. compresión de estructuras nerviosas (médula y/o raíces) y 2.  inestabilidad espinal que requiera fijación mediante instrumentación y/o artrodesi.

Como se mencionó, una de las indicaciones quirúrgicas del trauma espinal es la presencia de hematoma o de fragmentos óseos dentro del canal espinal comprimiendo la médula; estos se deben reiirar siempre que exista compromiso neurológico, especialmente si éste es parial.

Algunas lesiones traumáticas espinales producen la herniación del disco intervertebral con compresión medular o radicular; éstas pueden requerir un abordaje anterior de la columna para descomprimir la médula espinal o raíces. En estos casos se extrae el disco intervertebral, se descomprimen las estructuras nerviosas y se coloca un injerto óseo generalmente de cresta ilíaca o un material de osteosíntesis para lograr una artrodesis y fijación del segmento afectado.()

La segunda indicación quirúrgica en el trauma espinal es la inestabilidad segmentaria, la que frecuentemente produce dolor espinal y en el grado más severo el desplazamiento anormal de las vértebras puede producir una lesión de la médula y/o raíces espinales que hasta ese momento se encontraban indemnes. Existe una gran variedad de elementos disponibles comercialmente para corregir la inestabilidad espinal fijando la columna en los segmentos comprometido

  

REFERENCIAS BIBLIOGRÁFICAS

Burke DC. Traumatic spinal paralysis in children. Paraplegia. 11:268-276,1974

Fader AL, Jacobs TP Moughey MS et al: Endorphis in experimental spinal injury: Therapeutic effect ofnaloxone. Ann Neu- rol 10326,1981

Jodoin A, Dupuis Frase M, Beaumont E Unstable fractures of thoracolumbar spine: a 10 year experience at Sacre-Coeur Hospital. JTrauma24:197-202,1985

Wolman L The neuropathology oftrau- matic paraplegia. Paraplegia 1 :232-251, 1% Erickson DL, Lo J, Michaelson M. Control ofintractable spasticity with intra-thecal morphine sulphate. Neurosurgery 24236238,1989

Reid DC, Hu R, DavisLA. The nonope-rative treatment of burst fractures ofthe thoracolumbar junction. J Trauma 28-1188-1194, 1988

Holsworth F W Fractures dislocations of thespine. JBone JointSurg5X1534-1551, 1970

Holness RO, Huestis WS, Howes WJ, Langile RA. Posterior stabiiization with an interlaminar clamp in cervical injuries: technical note an review of the long term experiencewith the method. Neurosurgery Kalfas 14-318,322,984

Kalfas I, Wilberger J, GoldbergA, Prostko ER Magnetic resonance imaging in acute spinal cord trauma. Neurosurgery 24:295-259,1989

Louis R. Surgery ofthe Spine. Springer Verlag, Berlin 1983

Wilder GL. Hypothesis: the etiology of midcervical quadriplegia afier operation with the patient in the sitting position. Neurosurgery 11530-531,1982

Epstein NE, Epstein JA, Carras R Unila-teral S1 root compression syndrome caused by fracture ofthe sacrum. Neurosurgery 19-125-1027,1986

Holsworth FWFractures dislocations and fracture dislocations of the spine. J Bone Joint Surg45B:6-20,1963

Long DM, Filtzer DL, BenDebba M, Hendler NH. Clinical features of the failed-back syndrome. J Neurosurg 6961, 1988

Rawlings III CE, Wilkins RH, Martínez S, Wilkinson RH. Osteoporotic sacra1 fractures: A clinical study. Neurosurgery

Roberson GH, Llewellyn HJ, Taveras JM. The narrow spinal canal syndrome. Radiology 10789,1973

Wilberger JE, Chedid MI2 Acute cervical spondylotic myelopathy Neurosurger y 1188-1194,1988

Frymoyrer NKragMH. Spinal Stability and Instability: Definitions, Classification and General Principles of Management.  In: Dunsker SB, ShimedekHHFymoyer J Kahn IIIAK (eds) The Unstable Spine Gmne & Stratton, Inc. Orlando, 1986

Levy WJ, Gallo C, Watts C. Comparison oflaser and radio frequency dorsal root entry zone lesions in rats. Neurosurgery

Perot PL, Munro DD. Transthoracic moval ofmidline thoracic disc protrusions causing spinal cord compression. J Neurosurg3 1:452-458,1968

Dyste GN, Hitchon PW Girton RA, Chapman M. Effect of hetastarch,  mannitol, and phenylephrine on spinal cord blood flow following experimental spinal injury. Neurosurgery 24,228-235, 1989

Holh M. Normal motions in the upper portion of the cervical spine. J Bone and Joint Surg46-A 1777,1964

Pennig L. PrevertebraL hematoma in cervical spine injury: incidence and etiological significance. Am J Neuroradiol 1:557,1980

Eisen A, Hoirch M. The electro diagnostic evaluation ofspinal root lesions. Spine 8:98,1983

Flesch JR, Leider LL,Erickson DI., Chou SN, Bradford DS. Harrington inshumentation and spine fuion forr unstable fracnires-dislocations of the thoracic and lumbarspine. JBoneand Joint Surg59-A143-153, 1977

Holh M, Baker HR The atlanto-Axial Joint. J Bone and Joint Surg 46-A 1739, 1964

Levy WJ, Dohn DF, Hardy RW Central cord syndrome as a delayed postoperative complication of decompressive larninectomy Neurosurgery 11:491-495,1982

Kaufman HH, Jones E. The pnnciples of bony füsion. Neurosurgery24264-270,1989

DuckerTB, Saul TG. Early Myelography in acute cervical cord injury. In: Tator CH (ed) Early Management ofAcute Spinal Cord injury Raven Press, NewYork, 1982.

Kassel E. Myelography and computed tomography for diagnosis of acute cervical cord injury. In: Tator C (ed) Early Managernent ofAcute Spinal Cord Injury  Raven Press, NewYork, 1982. pp. 113-144

Paul RL, Michael RH, Dunn JE,Wfiams JPAnterior transthoracic surgical decompression of acute spinal cord injuries. J Neurosum43:299-307.175

White AA, Panjabi MM. Clinical Bio- Study offuntional recovery produced by mechanics of the Spine J.B. Lippincott Philadelphia 1978 delayed localized cmiingafter spinal cord Philadelphia 1978 the odontoid process ofthe axis. J Bone injuryinprirna~.JNeurouurg29:113,1968 bution to the study oflate cervicalsyringomyelic syndromes after dorsal or lumbar traumatic paraplegia. J Neurol Neurosurgand Psychiatr3 1 :99- 105,1968

Feuer H. Management ofacute spine and spinal cord injuries. Arch Surg3:638,1976

 

Kasdon DL, Lathi ES. A prospective study ofradio frequency rhizotorny in the treatment ofposttraumatic spasticity. Neurosurgery 15:526-529,1984

Penn RD, Kroin JS. Continous intrathecal baclofen for severe spasticity. Lancet 125157,1985

Zimmerman E, Grant J, Vise M, Jashon D, Hunt WTreatment ofJefferson hcture with a halo apparatus. J Neurosurg 44:372,1976

Hermanus N, de Becker D, Hauzeur Jl The use ofCT scanning for the study of posterio lumbar intervertebral articulations. Neuroradiology 24: 159,1983

Rowed DW Value of somatosensory evoked potentials for prognosis in partial cord injuries. In: Tator CH (ed): Early Management ofSpinal Cord Injury Raven Press,NewYork, 1982 pp 167-180

Dujovny M, Laha RlC Yonas H. Surgical management ofspasticity. In: The Patient With Spinal Cord Injury Ravitch MM. Year Book Medical Publishers, Inc. Chicago

Garza-Mercado R. Traumatic extradural hematoma ofthe cervical spine. Neuro

Komberg M, Rechtine GR, Hemdon WA, Reinert CM, Dupuy TE. Surgical sta- bilization ofthoracic and lumbar spine hctures: a retrospective study in a military population. JTrauma 24: 140-146,1984

Parke WWApplied Anatomy of the Spine en: Rothman RH, Simeone FA: The Spine WB. SaundersCompany, 1982.p~. 1851

Dennis E The three column spine and its significance in the classification of acute thoracolumbarspinal injuries. Spine 8:8 17, 1983

Gay JR. Abbott KH. Common whiplash injuries oftheneck JAMA 152:1698,1953

Heros RC. Spinal Cord Compression. In:Neurological and Neurosurgical Intensive  Care. RopperAH, Kennedy SK, Zervas NT (eds). Baltimore,UniversityParkPress,

Patterson RH,Arbit E.Asurgicai approach through the pedicle to protruded thoracic discs. J Neurosurg48:768-772,1978

Hanssen AD, Cabanela ME. Fracture of the densin adult patients. JTrauma27928, 1987

Larson SJ. Holst RA, Hemmy DC, Sances A. Lateral extracavitary approach to traurnatic lesions ofthe thoracic and lumbar spine. J Neurosurg45:628 -37,1976

RossierAB, WernerA, Wildi BJ. Contribution 1980. pp. 249-253 urgery 24:4 10-4 14,1989

Joint Surg (Am) 56A: 1663,1974

Cybulski GRStone JL, Kant R Outcome oflarninectomy for civilian gunshot injuries ofthe terminal spinal cord and cauda equina: Review of 88 cases. Neurosurgery 24392-397,1989

Pal JM, Mulder, DS, Brown RA, Fleiszer DM. Assesing Multiple Trauma: 1s the cervical spine enough?. J Trauma 28: 1282, 1998

Panjabi MM, Pelker RF: White AA. Biomechanics ofthe Spine. In: Wilkins RH, Rengachary SS (eds): Neurosurgery Vol 111 Mc Graw Hill Book Company  NewYork, 1985.p~. 2219-2227

Schlesinger EB, Taveras JM. Factors in the production of "cauda equina" syndromes in lumbar discs. Trans Amer Neurol Ass 78:263,1953

Cybulski GR, Penn RD, Jaeger RJ. Lower extremity functional neuromuscular stimulation in cases ofspinal cord injury. Neurosurgery 15132-146,1984

GerlockAJ, Kirchner SG, Heller RM, Kaye JJ. The Cervical Spine in Trauma WB. (eds) : Advance Exercises in Diagnostic Radiology. Saunders Company, Phila- delphia, 1978. Management of Acute Spinal Cord Injury Raven Press, New York, 1982. pp. 4 1-52. (1 1)

Herkowitz HN, Rothman RH. Subacute instability ofthe cervical spine. Spine 9348, 1986

 

Albin MS. Acute Spinal cord trauma: In Textbook of Critica1 Care. Shoemaker WC,ThompsonWL, HolbrookPR (eds). Philadelphia, WB Saunders Co., 1984. pp. 928-936

Delaney JM. Medical management of  spasticity. In: The Patientwith Spinal Cord Injury. Ravitch MM(ed) Year BookMedical Publishers, Inc. Chicago, 1980. pp. 245248

Gehweiler JA, Osborne RL, Becker RE The Radiology oNertebral Trauma. WB. Saunders Company, Philadelphia, 1980

Kirkaldy -Wills WH, Wedge JH, Yong Hing K, Reilly J. Pathology and pathogenesis of lumbar spondylosis and stenosis. Spine 3:3 19-328,1978

Luce JM. Medical management ofspinal cordinjury. CritCareMed 13:126,1985

Ostherholm JL, Mathews GL. Altered nor epinephrine metabolism following experimental spinal cord injury Part 2 Protection against traumatic spinal cord hemorrhagic neuosis by nor epinephrine synthesis blockade with alpha methyltyrosine. J Neurosurg36395,1972

Sabiston C e Wing E? Sacra1 fractures: Roda JMrGonzález C, Blazquez MG, Classification and neurologic irnplications. Alvarez ME Arguello C. Intradural her- Neurosurgery 1 8 1 1 13- 1 1 15,1986 niated cervical disc. J Neurosurg 278,1982 66. Albin MS, White RJ, Acosta-Rua G, et al.

De la Torre JC, Johnson CM, Goode DJ, et al. Pharmacologic treatment and evaluation ofpermanent experimentalspinal cord trauma. Neurology 25:508,1975

Luce JM, Culver BH. Respiratory muscle fünctioninhealthanddisease.Chest81:82, 1982.

Hamilton AJ, Black PMcL, Caw DB. ditions. NeUrosurgery21:186-192,1987 tral cervical cord injury management. Neurosurgery 15:367-372,1984 85. Han S y Witten DM, Mussleman Jl? Jefferson fracture ofthe atlas. J Neurosurg 44:368,1976 litatingpatients. JTrauma 25:423,1985 102.Hadley MN, SonntagVKH, Amos R, Hodak JA, Lopez LJ. Three 4imensional computed tomography in the diagnostic ofvertebral column pathological con Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury. J Neurosurg 11:546-577,1954

Menezes AH, Van Gilder JC, Graf CJ, McDonnell DE. Craniocervical abnormalities. J Neurosurg, 53:444,1980

Osterholm JL, Alderman JB, Triolo AJ, D’Amore BR, Williams HD. Oxygenated fluorocarbon nutrient solution in the treatment of experimental of spinal cord injury Neurosurgery 15:373-380,1984

Sindou M, Mifiud JJ, Boisson D, Goutelle A. Selective posterior rhizotomy in the dorsal entry zone for treatment ofhyperspasticity and pain in the hemiplegic upper limb. Neurosurgery 18:587-595,1986

Maiman DJ, Larson SJ. Management of odontoidfractures. Neurosurgery, 11:471, 1982

Mckenzie RN. Anesthesia in acute cervical cord injuries. In: Tator CH (ed): Early

Management ofacute Spinal Cord Injury RavenPress, NewYork, 1982. pp. 219-224

O’Donell WF, Taylor R. Genitourinary Problems of Spinal cord trauma. In: The Patient With Spinal Cord Injury. Ravitch MM(ed) Year BookMedical Publishers, Inc. Chicago, 1980. pp. 216-228

Sindou M, Jeanmonod D. Microsurgical

DREzOtomy fbrthe treatment ofspasticiy and pain un the lower limb. Neurosurgery

Maiman DJ, Barolat G, Larson SJ.

Management of bilateral locked facets of the cervical spine. Neurosurgery 18:542- 547,1986

Silver JR Moulton A. Prophylactic anticoagulant therapy against pulmonary emboli in acute paraplegia. Br Med J 2:338, 1923

Macnab 1. The traction spur. J Boint Joint Surg53-k663,1971

Meirowsky AM. Penetrating wounds of the spinal canal: Problems of Paraplegia and notes on autonomic hyperreflexia and blockade. Clin Orthop 2790- 1 1 O, 1963 Ostherholm JL, Mathews GJ. Altered nor epinephrine metabolism following experimental spinal cord injury. J Neurosurg 36386,1972

Sharkey PC, Halter JA, Nakajima K. Electrophrenic respiration in patients with high quadriplegia. Neurosurgery 24:529-535,1989

Goodman ML, Nelson PB. Brain abscess complicatingthe use ofa halo orthosis.

Neurosurgery 2027-30,1987 Bose B, Northrup BE, Osterholm JL, Cotler JM, Di TunnoF. Fkanalysis ofcen- 24:655-670,1989

Contrasting actions ofnaloxone in expen- mental spinal cord trauma and cerebral isquemia: a review. Neurosurgery 2 1 : 186-192,1987

Kirkaldy-W&s WH. Lumbar spondylosis and stenosis and stenosis. In: Cauthen JC (ed) Lumbar Spine Surgery, Williams & W&ns Baltimore, 1983

Stauffer ES. Rehabilitation ofspinal Cord-Injured Patient In: Rothman RH, Simeo-neFA(eds): TheSpineWB. SaundersCompany, Philadelphia, 1982. pp. 11 18-1 131

BogdukN, Long DM. The anatomy of the so-called "articular nerves" and their relationship to facet denervation in the treatment of low-back pain. J Neurosurg 513172-177,1979

Hardy AG. Cervical Spinal cord injury without bony injury. Paraplegia 14:296 1997

Kelly DL, Lassiter KRL, Caloquero JA. Effect of local hypothermia and tissue oxygen studies in experimental paraplegia. JNeurosurg33:554,1970

Marshall JJ. Judicial hanging. Br Med J 2:779,1988

Black PMcL, Baker MF, Snook Cl? Experience with externa1 pneumatic calf compression in Neurology and Neurosurgery Neurosurgery 18:440144,1986

González EG, Hajdu M, Bruno R, Keim H, Brand L Lumbar spinal stenosis: Analysis of pre- and postoperative somatosensory woked potentials. Arch Phys Med Rehabil66:11,1985

HaughtonVM, Williams AL. Computed Tomography ofthe Spine. The C.V Mosby Company, St Louis, 1982

Maiman DJ, Sanford L, Benzel EC. Neurologicai improvement associated with late decompreSSion of the thoracolumbarspinal cord. Neurosurgery 14:30-307,1984

Cottrell JE, Newfield e Giffin Je Shwiry B. Spinal Cord injury. In: Newfield e CottreUJEeds: Handbookof Neuroanesthesia. Little Brown and Company. Boston, 98. Gienn- Phelps L Diaphragm pacing by electrical stimulation ofthe phrenic nerve. Neurosurgery 17 974-984,1985

Kekosz VN, Hilbert L, Tepperman PS. Cervical and lumbopelvic traction -to stretch or not to stretch. Post grad. Med 80:187,1986

Sypert GW Externa1 Spinal orthotics. Neuros~1rgery20:642-649,1987

Cox SAR, Weiss SM, Posuniak EA,  Worthington Prioleau M, HeWey G. Energy expenditure after spinal cord injury: An evaluation of stable rehabi- 1983. pp. 338-351

Compty M. Selection ofpatients for surgical management after acute cervical spinal cord injury. In: Tator CH (ed): Early Management ofAcute Spinal Cord Injury RavenPress,NewYork, 1982.p~. 197-217

Glenn WWL, Holcomb BEE Mc Laughlin AJ, et al. Totalventilatory support in a quadriplegic patient with radio frequency electrophrenic respiration . N Engl JMed286513,1972

SturmJT, Perry F. Injuries associateswith fractures of the transverse processes of the thoracic and lumbar vertebrae. J Trauma 24597-599,1984

Brown M. The Pathology oflumbar Disc disease. In: Rothman RH, Simeone FA (eds): The Spine. W. Saunders Company Philadelphia, 1982.p~. 510-521

Cloward RB. Acute Cervical Spine Injuries. Clinical Symposia Vol 32 Number 1, Ciba Pharmaceutical Company, Summit, New Jersey, 1980

Hadley MN, Dickman CA, B m e r CM, SonntagVKH. Acute traumatic atlas h ctures: Management and long term outcome. Neurosurgery23:3 1-35,1988

Kaufman HH, Rowlands B J, Stein D, Kopaniky DR, Gildeberg PL. General metabolism in patients with acute paraplegia and quadriplegia. Neurosurgery 16309-313,1985

Stauffer RN. Coventry MB. Posterolateral Lumbar spine fusion -analysis of Mayo Clinic Series. J Bone and Joint Surg 54-k1195-1204,1972

Gronert GA, Theye RA. Pathophysiology of hiperkalemia induced by succinylcholine. Anesthesiology 43:89,1975

W&sbrond~Gerbershagen HU. Chronic pain in paraplegics 15:933-934, 1984

Mikhael MA, Cinc 1, Tarkington JA, Vick N. Neuroradiological evaluation of lateralrecesssyndrome.Radiology 14097,1981

Trafton PG, Boyd CA. Computed tomography ofthoracic and lumbar spine injuries. JTrauma24:506,1984

Nashold BS, Bullitt E. Dorsal root entry zone lesions to control central pain in paraplegia. JNeurosurg55:414-419,1981

Syracuse DC, Seaver PR, Amato JJ. Aortic gunshot injury and paraplegia: Preoperative definition with arteriography and computerized axial tomography. J Trau- ma25:217-273,1985

Griffiths IR. Vasogenic edema following acute and chronic spinal cord compression inthe dog. J Neurosurg42:155,1975

Hadley MN, Brower CM, Lin SS,Scantag VKH. New Subtype ofacute odontoid fractures (Type IIA). Neurosurgery22:67-71,1988

TaylorAR. The mechanism ofinjury to spinal cord in the neck without damage to the vertebral column. J Bone Joint Surg (Br) 33B:543-547,1951

Meyer GA, Berman IR, Doty DB, et al. Hemodynamic responses to acute quadriplegia with or without chest trauma. J Neurosurg34: 168,1971

Thompson GB. Acute Cervical Spinal Cord Injury: Clinical Assessment and Classification of Neurological Deficit. 1n:Tator CH (ed): Early Management of Acute Spinal Cord Injury. Raven Press, NewYork, 1982.p~. 1-6

Burrington JD, Brown C, Wayne ER, Odom J. Anterior approach to the thoraco1umbarspine.Arch Surg 11 1:456-463,1876

Wallace MC, Tator CH. Successhl improvement ofblood pressure, cardiac output and spinal cord blood flow after experimental cord injury Neurosurgery 20710-715,1987

Walsh JVC: Stevens DB, Young AB. Traumatic paraplegia without contiguous spinal fracture or dislocation. Neurosurgery 12:439145,1982

Grundy BL Monitoringofsensory evoked potentials during neurosurgical operations: methods and applications. Neurosurgery 11:556-575,1982

Wallace MC, Tator Ch. Failure ofblood mnshsion or naloxone to improve clinical recovery after experimental cord injury. Neurosurgery 19:489-494,1986

Neuwelt EA, Coe Mf, Wilkinson AM, Avolino ACE. Oregon head and Spinal cordinjury prevention program and evaluation. Neurosurgry 24:453-458,1989

Wallace MC, Tator CH. Failure ofnalo-xone to improve spinal cord blood flow and cardiac output afier spinal cord injury Neurosurgery 18:428-432,1986

Ciric 1, Milkhael MA Tarkington JA, VickNA. The lateral reces syndrome. J Neurosurg53:433,1980

Chance CQ. Note on type of flexion fracture ofthe spine. Br J Radio1 2 1 :452, 1948

 Weber RK. Respiratory management of acute cervical cord injuries. In: Tator C H (ed): Early Management ofAcute Spinal Cord Injury &ven Press, NewYork, 1982. pp. 2 13-2 17.

 

 Haga su consulta por tema