Focus on Spinal Injuries in Multiple Trauma Patients

摘要

Treatment of spinal injuries and fractures of the vertebral bodies has changed substantially in recent years. In particular management of fractures of thoracic and lumbar spine has been improved as a consequence of the results of multicenter trials. One major issue has been the thorough classification of the fractures into the three main types with instability in compression, flexion-distraction, or rotation. In addition reconstruction of the anterior column and in particular of disrupted disks by dorsal fixation alone even with additional cancellous bone grafting has been found inadequate. For compound unstable fractures it has been proven, that a combined dorsal/ventral approach with a so called 360?stabilisation will lead to the best functional and radiological results. However, open thoracotomy or lumbotomy are associated with high systemic and local morbidity, so that meanwhile minimal invasive approaches using endoscopic visualization have been established as routine procedure.