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55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

25. bis 28.04.2004, Köln

Intra-institutional guidelines for the treatment of lesions to the spinal column in spinal cord injury

Ein institutions-angepasstes Protokoll für die Behandlung des Wirbelsäulenschadens bei traumatischer Querschnittslähmung

Meeting Abstract

Suche in Medline nach

  • corresponding author Patrick J. Kluger - Consultant Surgeon in Spinal Injuries, National Spinal Injuries Centre Stoke Mandeville Hospital, Aylesbury /UK

Deutsche Gesellschaft für Neurochirurgie. Ungarische Gesellschaft für Neurochirurgie. 55. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 1. Joint Meeting mit der Ungarischen Gesellschaft für Neurochirurgie. Köln, 25.-28.04.2004. Düsseldorf, Köln: German Medical Science; 2004. DocDI.01.10

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Veröffentlicht: 23. April 2004

© 2004 Kluger.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.




Acute injuries to the spinal cord generally require urgent treatment. In some conditions, like progressive paralysis, immediate intervention is needed. Therefore, a department accepting these patients should establish guidelines of good practice in treatment, which help less specialised members of their staff, to take appropriate action. Further, such guidelines allow a focussed training of staff. The subsequently achieved qualifications determine the right skill-mix for the set up of on-call plans, which meet the requirements of organisational responsibility. When, from February 2000, the author was asked to introduce a comprehensive service of vertebral trauma treatment into a traditionally conservative spinal cord injury unit, the definition of such a policy presented the first important step forward.


Paramount goals in the treatment of spinal trauma with transverse lesion are: A) the decompression of the spinal canal, B) the resilient elimination of traumatic deformity, and C) local stability allowing early mobilisation of the patient, without external support. To achieve these goals, the least possible number of mobile segments should undergo definite bony fusion. Not all methods of treatment in spinal trauma are easily applicable in acute injury e.g. primarily anterior surgery in thoracic injuries often accompanied by lung contusions. The given skills of team members, as well, may restrict the useable range of methods in the acute phase, such as endoscopic techniques, or combined posterior-anterior procedures. In addition, the 24 Hs availability and -quality of technical equipment, and of supporting services, have to be taken into account, when drafting a stringent policy. Further, the policy only can provide guidance, when referring to an accepted method of injury classification.


Based on the AO classification for the subaxial spine, and on the specific classifications for the occipito-cervical junction, a policy was outlined, respecting definite standards of spinal alignment, which are, as long-term results: The injured segment's translational or rotational displacement is not accepted. Kyphotic post-traumatic segmental deformity is accepted, if not exceeding 0º in the cervical and in the lumbar region, or 30º at the thoracic and 20º at the levels T11-L2. The differences in surgical experience were taken into consideration by postponing necessary anterior procedures for reconstruction of the anterior column to a secondary stage of intervention. Protocols for certain non-surgical procedures, such as quick closed reduction of cervical dislocations, were included into the guidelines, too. By discussing the guidelines regionally, and on the internet, a peer review was performed.


A policy in good practice for treatment of spinal injuries has to consider local conditions. The example presented can be used as a draft proposal. Once established, the protocol provides guidance to junior staff, it allows responsible organisation of the team and, once made public in the hospital, it will help supporting services like radiology, anaesthetics, ITU and theatres, to adjust their organisations to the needs.