Emergency War Surgery NATO Handbook: Part IV: Regional Wounds and Injuries: Chapter XXXIII: Wounds and Injuries of the Spinal Column and Cord
United States Department of Defense
Peer Review Status: Internally Peer
Reviewed
Emergency surgery is indicated in the following closed injuries of the spinal cord: 1) the spinal-cord-injured patient with an incomplete lesion who deteriorates neurologically, and 2) the neurologically intact or incomplete patient with an unreducible dislocation of the vertebral column. Where vertebral body fracture results in neural canal compromise, an anterior decompression is the indicated route in order to minimize anterior spinal artery compromise However, consideration must be given to the mechanics of the spinal column injury so that a stable column is not rendered unstable by the decompression. The operative approach is directed to the site of neurological compromise and to the level of spine instability. Consideration should be given to stabilizing the spine at the time of decompression. Rarely in the presence of a complete neurological injury, when subdural or extradural hematomas or extrinsic masses resulting from fracture or soft-tissue fragments are decompressed, will neurological improvement occur. Individual nerve roots, in contrast to the spinal cord, frequently demonstrate recovery, with or without surgery. Some recovery of function can also be anticipated from injuries to the cauda equina, since this structure is also made up of peripheral nerves.
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