J Korean Soc Spine Surg.  2001 Sep;8(3):413-418. 10.4184/jkss.2001.8.3.413.

Neural Injury and Recovery of the Thoracolumbar Spine Fractures

• Shim DM
• Kim TK
• Song HH
• Ha DH
• Kim KJ

• KMID: 2209764
• DOI: http://doi.org/10.4184/jkss.2001.8.3.413

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.

Keyword

Thoracolumbar spine fracture; Neural injury and recovery

MeSH Terms

Calcium
Cause of Death
Classification
Glutamic Acid
Humans
Kyphosis
Lipid Peroxidation
Methylprednisolone
Naloxone
Neurologic Examination
Shock
Spinal Cord
Spine*
Urinary Bladder
Calcium
Glutamic Acid
Methylprednisolone
Naloxone

Figure

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  Fig. 1. 골격 구조에 대한 척수 신경근의 분포

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  Fig. 2. CORR 233, Aug, 1988, p:173의 골절 분류: type I=B, type II=C, type III=D, typeIV=E

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  Fig. 3.

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