Prevention of secondary damage to the spinal cord, indications for urgent surgery in terms of spinal cord decompression

secondary damage to the spinal cord – a series of biochemical events that lead to the expansion of the original lesion after the trauma,
- primary changes – injury → in a few minutes – petechiae in the tissue, in an hour gray matter perfusion decreases, tissue acidosis occurs, in 4 h hemorrhagic necrosis already occurs,
- reduction of blood flow causes edema, progresses longitudinally and radially, tightens the pia mater, and this leads to compression of small subpial vessels, which does not exactly add much → deterioration of microcirculation,
- free radicals (VR) are formed and these cause further (secondary) damage,
the key substance limiting the occurrence of VR is methylprednisolone– we start the therapy 3 hours after the injury – initially a bolus of about 30 mg/kg weight, then after a 45-minute break we administer it continuously for 23 hours at a rate of 5.4 mg/h/kg,
the administration makes sense even after 8 hours after damage,
diagnosis - if damage to the spine is suspected - x-ray in two projections, CT aimed at the site of the lesion, MRI to clarify the diagnosis, exclusion of compression by a hernia or hematoma

Indications for urgent surgery in terms of spinal cord decompression

current methods of repositioning and stabilization of the spine usually also ensure the restoration of the patency of the spinal canal (and thus decompression of the spinal cord),
therefore, decompression laminectomies previously performed today are not indicated,
we resort to laminectomy (as a complement to repositioning and stabilization) when we need to revise the canal (remove fragments, protrusions, dura plastic, ...),
urgent decompression is necessary in all syndromes of partial spinal cord injury, especially in:
- progression of neurological findings,
- proven channel impassability,
- proof of bone fragments, hematoma or disc,
- in open wounds,
on the contrary, with symptoms of a transverse lesion lasting longer than 24 hours, emergency decompression usually does not improve the condition.

have a high susceptibility to the formation of pressure ulcers,
a long-term problem is bladder care,
- in the stage of spinal shock, there is urinary retention - frequent catheterization is necessary (it has fewer complications than a permanent catheter),
- when the micturition center is preserved (lesions above S2–S4) – practicing reflex automatic emptying,
- the reflex is triggered by intramural ggl. in the wall of the bladder - by pressure,
often in the first days there is a decrease in GIT peristalsis, up to paralytic ileus,
in Th spine lesions – care for breathing.