Spinal traumas are one of the leading traumatic lesions
that progress with high mortality and morbidity rates and affect the individual and society with its results.
Due to the fact that the right intervention in a short time affects the prognosis, there was a need for centers where the patient’s examination and treatment could be done adequately, and spinal trauma centers were established in some countries for this purpose.
In these centers, it is important to provide faster and standardized first aid to patients with spinal trauma. These injuries, which date back to very old times, are frequently seen due to traffic and work accidents, falling from height, industrial injuries, firearm injuries, sports injuries, which have increased in parallel with the industrial age. It is accepted that 30 people per million in the USA are at risk of spinal trauma.
Spinal traumas are seen at a higher rate in young people. The mean age is stated in the literature as 33.5 years. The male female ratio is 1 in 4. The most important reason
is traffic accidents.
It is accepted that 30 people per 1000.000 years in the USA are at risk of spinal trauma. Nowadays, there is an increase in vertebral fractures as a result of increasing traffic accidents, work accidents and falling from height. It has been reported in the literature that vertebral injuries are common in men between the ages of 15-34.
In our study, vertebral injury was observed most frequently in 13 (30.2%) patients and in cases aged 15-30 years. The most common cause of spinal trauma is traffic accidents. In a study by Hagen et al, falls were reported as 45% and motor vehicle accidents as 35%.
In the study of Burney et al, it was reported that vehicle accidents were 40%, falls 20%, and gunshot injuries 13.6%. Meyer et al. reported the causes of spinal trauma as 42% of traffic accidents and 22.8% of falls. In our study, when the mechanisms of injury were examined, falls from height were found to be 60.4%, traffic accidents 34.8% and diving 4.6%.
As seen in the studies in the literature, falls and traffic accidents are the most common causes of trauma. As in Hagen’s
study, falls took the first place in our study. It is seen that the etiology varies between regions and countries
.
The geographical structure and socio-economic reasons of the region may explain the first-line incidence of falls from height.
Hagen et al., in their series containing 238 patients, reported that 50% cervical, 33% thoracic, 18%
vertebrae in the lumbar region were injured when the distribution according to the affected regions was examined.
Of Meyer’s 2195 cases, 1372 (61%) were in the cervical region (7). In our study, 60.4% cervical, 23.2% thoracic and 16.4% lumbar vertebrae were affected. As in the studies of Hagen and Meyer, traumas in the cervical region are in the first place in our study. In a study by Alker, 22% of 312 cervical vertebral fractures and 21% of Bucholz’s 112 cases were found in the upper cervical region. In our series, 11 (42.3%) of the cases had pathology in the upper cervical region and 15 (57.69%) patients had pathology in the lower cervical region.
Since the most mobile segments of the spinal canal (C4,C5,C6, T12, L1,L2) are, the risk of injury is quite high in these segments.
10% of injuries occur in the cervicothoracic region. In the thoracic region, the spinal canal is narrower, the vertebrae are fixed and articulate with the thoracic cage
, greater force is required for injury to occur. Since the thoracolumbar junction is more mobile, the second most common injuries are seen in this region
.
Meyer reported that 42.9% of cases with acute spinal injury had multiple trauma in their series. Apuzzo et al. In their series of 45 cases
, they reported that 17.8% of the cases had cerebral cotosis, 9.8% had cranial fracture, 4.4% had pulmonary injury, and 4.4% had abdominal injury
(14). While 6.9% had cerebral lesions, 11.6% thoracic pathology, 2.3% had multiple extremity fractures
, 79% had no additional pathology.
Rates of spinal cord injury types detected in the first examination In the study of Zileli et al.
in the Aegean region in 1989: no finding (32%), tetraplegic (10%), tetraparetic (10%), paraplegic (13%) ), paraparesis(6%), cauda equina lesion(12%)(15)
, these rates in our study were:(4.6%) paraparesis(16.2%),paraplegia(11.6%),quadriplegia in 29 cases(67.4%) There was no neurological deficit.
It has been reported that 6000 deaths per year as a result of medulla spinalis injuries as a result of motor vehicle accidents in the USA. In the study of Burney
et al., the hospital mortality of patients with spinal injuries was reported as 17%(10). In an epidemiological study conducted in the Department of Aid
; 39 (6%) of 651 trauma patients had spinal trauma and mortality was 5.1%
. In this study, mortality was found to be 6.9%.
Spinal traumas are one of the leading traumatic lesions affecting the society with high morbidity and mortality. The patient
needs to be transported to an advanced center by providing immediate stabilization in a short time. All
patients with suspected spinal trauma should be subjected to neurological examination, radiological examinations should be performed, immobilization should be provided, and if there are additional pathologies, treatments
should be applied.
Things to consider after spine operations
The following information awaits our patient who has spinal surgery for any reason and should not forget;
It is not possible for any surgery to provide the innate body structure. The surgery was done for your income and
happiness and your future.
The aim of spinal surgery performed on you is to create a system that functions close to the body structure that comes from creation.
As a result, in spinal surgery, instruments that are placed externally are placed on the body’s innate body structure.
The number and type of these instruments vary depending on the problem. These instruments need to adapt to the body. For example, even with a dental filling, there is a time to get used to it. The adaptation period of the instruments to the body varies between 6 months and 1 year.
In spine surgery, as in all forms of treatment, there are losses as well as gains. The important thing should be the size of the gain
.
The most common complaints of our patients in spine surgery;
1. I can’t do my movements as I want: Depending on the level of the surgery, mobility restriction
occurs in spine surgeries. The degree of this limitation of motion is roughly 5% for each spinal segment made. In fact, existing
spine problems in patients have the problem of performing their movements as they want
, even though spine surgery has not been performed. However, the benefit in spine surgery is the elimination of pain and the prevention of advanced and possible nerve losses
.
2.I feel stinging while sitting, I feel heaviness: Such complaints are discomforts that the body is in the process of getting used to instruments
. It should not be forgotten that you will get used to these instruments as time passes and you will accept them as a part of your body
.
3. Worry about my sinkers slipping and breaking: It is not possible for duly placed sinkers to slip and break with small movements
. However, in the case of progressive bone resorption in elderly patients, mobility may develop in the platinums. In heavy accidents
or impacts, the sinkers may break. As it is known, every substance has a certain staying power. As time passes, metals get tired.
This is called metal fatigue.
4. It was necessary to take the sinkers attached to my waist after a certain period of time: The instruments placed on your waist are the materials accepted by the body
. It doesn’t matter if you have it. However, if the patient’s psychological structure does not allow the presence of instruments
or if the existing problem is reinforced with bones, platinums can be taken after 2 years.
5. Can the same problems develop after the platinum operation? Instruments placed on your waist keep a certain segment under control
but do not provide protection for segments above and below these segments. In other words, as a patient, you need to take care of yourself, protect yourself, and have a dialogue with your doctor after such surgeries
.
Problems that may develop in spine operations
Backbone operations are difficult and require experience. Spine surgeries are risky surgeries. These risks differ according to the spine
problem and its width. As the number of spine segments to be made increases, the problems that may arise increase.
In scoliosis and kyphosis surgery, the risks are higher and the complications that may arise are much higher. These early or late
complications may develop in all patients who require this surgery, as well as in all spine
surgeons who perform this surgery. Therefore, it is important that you are in chorus with your doctor and act in the same direction in harmony.
Early complications in spine surgery
1. Malposition of screws: that is, inability to place the screws in the appropriate place. In other words, the placement of the screws around the spine, not in the spine
. It carries the risk of reoperation
2. Nerve injuries: Damages in the nerves that go to the leg along the course of the screws. Motor and sensory symptoms may develop depending on the level
. .
3. Damage to the spinal cord membrane by the screws and the occurrence of cerebrospinal fluid leaks. It may carry the risk of reoperation.
4. Injury to the spinal cord carries the risk of paralysis. May require reoperation.
5. Congestion occurs in the nerve channels and the pain increases after the operation. It carries the risk of reoperation.
6.Wound infections:Requires wound opening:
7.Implant infections.Requires removal of the implant.
Late complications in spine surgery
1. Displacement of screws is usually caused by osteophorsis or severe trauma that develops over time.
2.Breakage of screws depends on metal fatigue or not placing screws of appropriate thickness or the quality of the instrument system
.
3. Displacement of the rods depends on the metal fatigue of the screw fastening systems, traumas or the quality of the system.
4. The development of hernia or slippage on the segment where the instrument is applied depends on the careless and careless behavior of the patient, traumas
.
5. The development of hernia or slippage under the appropriate segment of the instrument depends on the patient’s careless and careless behavior and traumas
.
Spine operations
Spine operations are operations performed within Brain and Nerve Surgery. The spine is an important structure that carries the load of the body to the legs
. The spine is also a structure that allows for certain mobility. While some developing problems in the spine cause mechanical pain
, some developing problems cause both mechanical and nerve pain. Regardless of the problem in the spine
, developing pain can create problems that prevent social, sexual, familial and professional life.
What kind of problems can occur in the spine?
There may be shifts in the spine, there may be fractures in the spine, curvatures in the spine may be kyphosis or scoliosis. These problems may require intervention according to their degree and age at detection
. There are problems that may develop due to interventions in the spine.
For example, in the case of a surgery that needs to be performed on a patient with spinal canal stenosis greater than 3 levels in the lumbar region
, spinal surgery is planned even if there is no slip, fracture, kyphosis or scoliosis in the spine. For example, spinal surgery can be planned for a case with 3 level lumbar disc herniation
depending on the surgery to be performed.
In the same way, there is slippage in the spine, but not in surgical dimensions, but there is a herniated disc and intervention is required, considering that the surgery to be performed
may increase the slippage, spine operations can be considered.
The aim in spine operations is to ensure the alignment in the spine, at least to prevent its progression.
