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

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