[Treatment of spinal injuries]

The treatment of spinal column injuries relies on the well founded knowledge in functional spinal anatomy. An exact diagnosis is based on a thorough clinical and neurological examination. X-rays, CT-scan and eventually an MRI examination. A fracture classification is imperative for further conservative and operative treatment. Fractures and fracture dislocations of the thoracic and lumbar spine are generally classified in groupings based on the three column theory of Dennis. The whiplash injury is the most common soft tissue injury of the cervical spine. The initial therapy of this trauma intends to achieve a fast reduction of pain and inflammatory tissue reactions. Of all fractures regarding the human beings the spinal column is affected in about one percent. The most common fracture localisation is the thoraco-lumbar spine. Fractures of the atlas (Jefferson fracture) and odontoid fractures type Anderson I and Anderson III are usually treated by a halo west for 8-12 weeks. Odontoid fractures type Anderson II are stabilised by screw fixation. Fractures below C 2 require an operative stabilisation in most cases. Ventral, dorsal and combined ventral-dorsal spondylodeses are performed. Fractures of the thoracic and lumbar spine are treated conservatively in about 80-90% of our cases. Fractures of the upper thoracic spine usually require no external fixation, functional treatment is possible. Fractures below Th 11 are treated by reduction and casting for 12 weeks. Within the last 15 years the operative treatment of these fractures continually increased. Dorsal stabilisation with pedicle implants prevailed in the last years. The aftercare of spinal trauma patients consists in an intensive physical therapy for at least three months.