STRUCTURE OF SPINAL CORD INJURY

Abstract

Annotation. Spinal cord injury (SCI) is a severe pathological condition resulting from damage to the vertebral column and spinal cord, accompanied by impairment of motor, sensory, and autonomic functions. This paper examines the structure of SCI , including the anatomical features of the spine and spinal cord, injury mechanisms, and morphological and functional changes associated with various types of injury. Particular attention is paid to the classification of injuries, their clinical manifestations, and the importance of timely diagnosis. Based on the data analysis, approaches to assessing the severity of injury and preventing complications have been developed. SCI is a pressing issue in practical medicine. The incidence of SCI is steadily increasing. According to literature reports, the proportion of spinal fractures in the overall structure of skeletal trauma has ranged from 2 to 18% of cases in recent years, with an upward trend. Damage to the spinal cord and its roots accounts for approximately 20% of all spinal injuries. Disability due to spinal cord injury hovers around 80%, two-thirds of whom are people of working age. Mortality from complicated spinal cord injury also remains high, reaching 35% according to summary statistics. The literature reviewed above clearly illustrates not only the prevalence and severity of spinal cord injury but also the importance of treating victims at all stages of surgical care. It is known that the key conditions for adequate surgical treatment of complicated spinal injury in the acute period include decompression of the spinal cord and its roots, correction of post-traumatic deformity, stabilization of vertebral segments, and prevention of degenerative changes in the spine and spinal cord. While the need for decompression in cases of spinal cord and root compression is currently non-negotiable and should be performed without fail, the choice of method for stabilization and correction of post-traumatic deformity remains controversial.

In the current stage of neurosurgery, increasing attention is being paid not only to eliminating vertebral -medullary conflict but also to maintaining stability in the operated segment, preserving its proper anatomical, spatial, and biomechanical relationships to prevent the development and progression of neurological disorders and degenerative changes in the intervertebral motion segments, as well as those adjacent to the injury level. The presence of an unstable injury creates a risk of secondary displacement or worsening vertebral displacement, which requires reliable immobilization of the spine or surgical stabilization of the damaged segment. The term " decompression -stabilization" surgery encompasses two key concepts, including both "decompression" and "stabilization," which define the goals of surgical treatment. "Decompression" refers to the release of the neurovascular structures of the spinal canal from one or more compressive factors (a displaced vertebral body, bone fragments, localized hemorrhages, foreign bodies, etc.). "Stabilization" refers to the elimination of mobility and immobilization of all damaged supporting structures in the spine being operated on. The tactics for performing this type of surgical intervention, particularly in emergency neurosurgical settings, require special attention when choosing the method of stabilizing the damaged spinal motion segment (SMS).

Fusion plays a significant role in ensuring the stability of the operated spinal segment . Maintaining stability in the operated spine after restoration of proper relationships creates the conditions for the formation of a complete bone block. Therefore, many authors discuss the need for additional posterior fixation of the injured spine. In this regard, the use of Harrington-type metal structures, parallel vertebral plates such as those used at the Central Institute of Traumatology and Orthopedics (CITO), titanium nickelide devices with shape memory effect (SME) and superelasticity (SE), as well as various variants of combined fusion using grafts in the treatment of complicated spinal injuries in emergency neurosurgical care, are worthy of consideration.

Undoubtedly, in such cases, the time course of the traumatic disease remains important and must be taken into account when choosing the stage, tactics, and extent of surgical intervention. These, in turn, depend on the timing of patient examination, the method of decompression, and the technique and reliability of metal implant placement. According to epidemiological studies and assessments of the organization of medical care for patients with spinal cord injury, many factors influencing the quality of treatment remain relevant. These include the training of neurosurgeons; late and poor diagnostics and their cost-effectiveness; the complexity and high cost of devices for metal osteosynthesis ; inappropriate surgical tactics; and the risk of potential complications. All of the above determines the feasibility of continuing research on improving the treatment of patients with spinal cord injury in the context of emergency neurosurgical care.