What Are the Different Types of Acute Spinal Cord Injury?

Spine and spinal cord injuries often occur in industrial and mining, traffic accidents, and can occur in batches during wartime and natural disasters. The injuries are severe and complicated, with multiple injuries, multiple injuries, many complications, poor prognosis when combined with spinal cord injury, and even cause lifelong disability or life-threatening.

Basic Information

Visiting department

orthopedics

Common locations

vertebral

Common causes

Direct or indirect violence

Common symptoms

Injury local pain, neck movement disorders, back muscle spasm, can not stand up

Spinal and spinal cord injury Spinal fracture classification

Based on the damage mechanism

(1) Classification of cervical spine fractures

According to the position of the cervical spine at the time of injury (flexion, upright, and extension), it is divided into the following four types.

1) Flexion injury refers to the cervical spine caused by violence during flexion, the front column is compressed, and the rear column is stretched. There are two types of compression fractures, fracture-dislocation.

2) Vertical compression injury The cervical spine was hit by vertical stress when it was in the upright position, without excessive flexion or overstretching force. It is divided into Jefferson fracture (bilateral anterior and posterior arch fracture of the first cervical vertebra), and burst fracture (comminuted fracture of the lower cervical vertebra, which is more common in C5 and C6 vertebrae).

3) Hyperextension injury No fracture-dislocation hyperextension injury The forehead face touches the ground and the neck is overstretched when falling. It also often occurs when driving a car at high speed, because of sudden braking or collision, due to inertia, the head hits The windshield or the backrest of the front seat forces the head to overextend (whip injury). The result of the injury: the cervical spine is moved backward, and there is a kyphosis of the spinal cord, which causes the spinal cord to be sandwiched between the contracted yellow ligament and the lamina, causing damage to the central canal of the spinal cord. Axial vertebral arch fracture The violence of this type of injury comes from the sacrum , causing the cervical spine to over-extend, forming a strong shear force in the latter half of the vertebrae, making the vertebral arch unbearable and causing vertical fractures. In the past, it was more common in people who were strangled, so it was also called fracture of the strangled person (Hangman fracture).

4 ) The mechanism of odontoid fracture is not clear. Violence may come horizontally, from front to back, through the skull to the dentate process. There may be several types of compound violence. Generally divided into three types (Anderson-D'Alonzo classification): type is avulsion fracture of the dentate process, type is the base of the dentate process, transverse fracture above the vertebral body, type , fracture of the upper vertebral body, Involve the superior articular process of the vertebra, one or both sides.

(2) Classification of thoracolumbar fractures

1) Denis classification Compression fracture: compression wedge deformation in front of the vertebral body. Burst-type fracture: The vertebral body is comminuted, and the fractured block is shifted to the periphery, and the backward displacement can compress the spinal cord and nerve. Flexion and distraction type (belt injury, Chance fracture): Transverse fractures of the vertebral body, vertebral arch and spinous process, but also damage to the anterior and posterior longitudinal ligament-intervertebral disc-posterior column ligament. fracture and dislocation type: forward or backward displacement of the vertebral body, may be accompanied by joint dislocation or fracture of the joint.

2) AO classification is based on the two-column theory. From A to C, the damage gradually increased. Type A: Axial instability, flexion compression (A1: compression fracture, A2: split fracture, A3: burst fracture). Type B: Sagittal instability, flexion stretch or posterior stretch injury (B1: Rupture of the posterior ligament structure caused by flexion stretch, damage to the intervertebral disc through the joint capsule forward; B2: Flexion stretch caused by the rear The ligament structure is broken and passes forward through the bony structures such as the vertebral arch and the vertebral body; B3: overstretching causes injury through the anterior column disc and complete fracture, with or without damage to the posterior ligament structure). Type C: Triangular instability, laterally staggered, caused by rotation violence (C1: Type A injury with rotation; C2: Type B injury with rotation; C3: Shear injury with rotation).

2. Based on stability after fracture

Can be divided into stable and unstable. For example, based on the classic three-pillar theory of spine, Denis divides thoracolumbar fractures into stable fractures (mild and moderate compression fractures, complete posterior column) and unstable fractures (all three columns are injured, such as bursts) Fractures, ligament injuries, and spine fractures and dislocations).

3. Classified by site

Can be divided into cervical spine, thoracic spine, lumbar spine fracture or dislocation. According to the anatomical part of the vertebra, it can be divided into vertebral body, vertebral arch, lamina, transverse process, spinous process, and articular process fracture.

Spine and spinal cord injury

1. Scoring system for the degree of spinal and spinal cord injury of thoracolumbar spine

(1) TLISS scoring system for thoracolumbar spine injury This system includes three aspects of injury mechanism, posterior ligament complex, and nerve function assessment. Different scores are given according to different situations. Finally, the scores of the three parts are added up, and the total score is used as the basis for selecting treatment.

Fracture morphology: 1 point compression; 2 points burst type; 3 points shear and rotation; 4 points stretch type;

Nerve injury: 0 points without injury; 2 points of nerve root injury; spinal cord or cone injury: 2 points of complete injury; 3 points of incomplete injury; 3 points of cauda equina injury;

Posterior ligament complex: 0 points for no damage; 2 points for uncertainty; 3 points for rupture. (MRIT ₂ weighted and T ₂ lipid-suppressed sequence images show a high signal or continuous interruption in the corresponding part of the PLC structure indicating a break).

If the total score is 3, conservative treatment is recommended; if the total score is 5, surgical treatment is recommended; if the total score = 4, conservative or surgical treatment can be taken in accordance with the specific situation of the patient. The total score is less than 4 points for non-surgical treatment, and more than 4 points are selected for surgical treatment, 4 points are both.

(2) Load sharing classification (LSC) scores from three aspects of vertebral comminuted degree, fractured piece displacement and kyphosis correction based on imaging data. Each item is scored on a 3-point scale based on the severity, and the three items are scored. The sum is the LSC total score. The higher the score, the more unstable the fracture. The classification quantifies the severity of the injury for the first time, but only considers the situation of vertebral fractures, and ignores the role of soft tissue and nerve injury on spinal stability.

2. Cervical Spine Injury Scoring System (CSSSS)

This system divides the cervical spine into anterior column (vertebral body, intervertebral disc, anterior and posterior longitudinal ligament), posterior column (spinous process, lamina, ligamentum ligamentum, ligamentum flavum) and two lateral columns (lateral masses, articular processes, joints and capsules) . In CT three-dimensional reconstruction, each column is scored according to fracture displacement and ligament breakage. The degree of injury gradually increases from 0 to 5, 1 point represents non-displacement fracture, 5 points represents fracture displacement greater than 5mm or complete ligament fracture. The total score is 20 points. When multiple segment injuries are involved, the most severe segment is calculated. There are some deficiencies because no cervical MRI data has been introduced and neurological status has not been considered.

Spinal and Spinal Cord Injury Classification

Frankel method

Proposed by Frankel in 1969. It divides the sensations below the injury plane and the state of motor retention into five levels: A. The depth sensation below the injury plane completely disappears and the muscle motor function completely disappears; B. the motor function below the injury plane completely disappears, and only some sensations including the palate area C. There are only some muscle motor functions below the injury level, no useful functions exist; D. Muscle functions below the injury level are incomplete and can be walked with crutches; E. Sensation of depth, muscle movement, and stool function are good, there may be pathology reflection. The Frankel method roughly grades the degree of spinal cord injury and has great practical value in the evaluation of spinal cord injury. However, there are certain defects in the evaluation of spinal cord and pony tail injuries, and the lack of judgment of reflex and sphincter function, especially for the evaluation of sphincter function. The expression of bladder and rectal sphincter function is not clear enough.

2.ASIA spinal cord injury classification

Currently recognized and widely adopted is the 1992 American Spinal Cord Injury (ASIA) classification revised according to Frankel classification. A. Complete injury: no sensory or motor function is retained below the level of spinal cord injury, including the sacral segment (S4 to S5). B. Incomplete injury: There are sensory functions including the sacral segment (S4 to S5) below the injured nerve plane, but no motor function. C. Incomplete injury: there is motor function below the injured nerve plane, and more than half of the vital muscle strength below the plane is below level 3. D. Incomplete injury: there is motor function below the injury plane, and at least half of the critical muscle strength below the plane is equal to or greater than level 3. E. Normal: The sensory and motor functions are normal. Compared with the Frankel classification, the ASIA classification has the following differences. First, the definition of ASIAA is a lack of motor and sensory function at 4 to 5. Second, ASIAB needs to retain the sensory functions of 4 to 5. Third, ASIAC has a quantitative criterion: half of the muscles below the injury level have a score of 3/5 or less. Since 3 points indicate anti-gravity, this means that half of the muscle strength does not exceed your own weight.

3. International Spinal Cord Injury Classification Standard

The International Spinal Cord Injury Scoring Standard is a method for expressing the severity of spinal cord injury using points based on the National Acute Spinal Cord Injury Research Association (NASCIS) scoring standard (18). It quantifies the degree of spinal cord injury and facilitates statistical comparisons and academic exchanges. Therefore, the international classification standard for spinal cord injury is considered to be the most advanced scoring method for spinal cord injury.

The neurological examination of the International Spinal Cord Injury Neurological Standard includes sensory examinations, motor examinations, and digital anal tests to test the external anal sphincter. Sensory examination is mainly to check the key points of 28 skin areas on each side of the body. At each key point, check 2 kinds of sensations, namely acupuncture and light touch, and evaluate the scores according to 3 levels (0 is missing; 1 is obstacle; 2 is normal. Feelings that cannot distinguish between blunt and sharp stimuli are rated as 0). Test results There are four conditions in each skin area: right acupuncture, right acupuncture, left acupuncture, and left acupuncture. Adding the skin area scores on each side of the body yields two total sensory scores (acupuncture score and light touch score). The sensory score is used to indicate changes in sensory function. The exercise test mainly examines the key muscles of 10 pairs of sarcomere on each side of the body. The examination order is from top to bottom, and the muscle strength of each muscle is 0 to 5 clinical grading method. These muscles selected for examination are consistent with the innervation of the corresponding segment and are convenient for clinical supine examinations (other positions are often contraindicated in spinal cord injury). According to the examination results, the scores of both sarcomerees are collected to obtain the total exercise score, and this score is used to represent the change in motor function.

Clinical manifestations of spinal and spinal cord injuries

Spinal fracture

Has a history of severe trauma, such as falling from a high altitude, hitting a head or neck or lower back with a heavy object, a landslide accident, a traffic accident, etc. The patient experienced local pain, difficulty standing and turning over, cervical spine fractures may have neck movement disorders, and lumbar spine fractures may have lumbar back muscle spasms. Local fractures can be associated with localized posterior deformities. Retroperitoneal hematomas stimulate the peritoneal ganglia and slow down bowel movements. Abdominal distension, abdominal pain, and even intestinal paralysis often occur. Sometimes it needs to be distinguished from abdominal organ damage. If paralyzed, it is manifested as limb or bilateral lower limb sensation and movement disorders. Complications: Attention should be paid to whether there are injuries to the brain, chest, abdomen and pelvic organs.

2. Combined spinal cord and nerve root injuries

After spinal cord injury, motor, sensory, reflex, and sphincter and autonomic nerve functions below the injury level are impaired.

(1) Sensory disorders Pain, temperature, touch, and proprioception below the level of the injury weaken or disappear.

(2) Dyskinesia During spinal shock, paralysis occurs below the spinal cord injury segment, and the reflex disappears. If the spinal cord is traumatized after the shock period, upper motor neuron paralysis occurs, muscle tone increases, and tendon reflexes become hypertonic, with palatal and ankle clonus and pathological reflexes.

(3) Sphincter dysfunction Spinal cord shock is characterized by urinary retention, neurological reflex activity disappears, and bladder detrusor muscle paralysis forms a tension-free bladder. After the shock period, if the spinal cord injury is above the level of the diaphragm, an auto-reflex bladder can be formed (the detrusor reflex exists), urination is laborious, and the residual urine is less than 100ml, but the urine cannot be arbitrarily discharged. Squeeze the abdomen with your hands) or empty the urine with a urinary catheter. If the level of spinal cord injury is in the conic sacral pulp or sacral nerve root, urinary incontinence will occur, and constipation or incontinence will also occur in stool.

(4) Incomplete spinal cord injury Some sensory and motor functions are reserved below the injury plane, which is called incomplete spinal cord injury. There are the following clinical types: Anterior Cord Syndrome: quadriplegia occurs, and the lower extremity is heavier than the upper extremity, but the position and deep sensation of the lower extremity and perineum are still maintained, and sometimes even the superficial sensation is retained. This type has the worst prognosis among incomplete injuries. Central Spinal Cord Syndrome (Central Cord Syndrome): Most occur in hyperextension of the cervical spine, manifested as quadriplegia below the level of injury, upper limbs are heavier than lower limbs, and there is no sensory separation. Brown-Séquardsyndrome: The motion and deep sensation of the ipsilateral limb below the injury plane disappeared, and the pain and temperature of the contralateral limb disappeared. Posterior Cord Injury Syndrome (PosteriorCordSyndrome): Motor function and pain, temperature, and sensation exist below the level of spinal cord injury, but deep sensation disappears in whole or in part.

Spine and Spinal Cord Injury Examination

1. X-ray inspection

Routine photography of the spine is in the lateral position, and if necessary oblique. The vertebral body should be observed in the upright position for deformation, the space between the upper and lower spinous processes, and the pedicle spacing. The lateral position should be observed for the spinous process space to be enlarged. Measurements: degree of vertebral compression; degree of dislocation; spine Posterior arch angle, normal thoracic posterior arch angle is not more than 10 °, and it is a physiological protrusion in the cervical and lumbar spine.

The degree of spinal cord injury is indirectly observed according to the degree of X-ray dislocation. In the thoracic spine and spine, the degree of dislocation is more than degree, and most of them are complete spinal cord injuries with little recovery. In cervical and lumbar spine, the severity of X-rays and the degree of spinal cord injury may be different. Exactly.

After the acute phase, in order to check the stability of the spine, anterior flexion and posterior extension of the spine should be taken. If the anterior or posterior edge of the upper and lower adjacent vertebrae is shifted back and forth> 3mm, it is a sign of instability.

2.CT inspection

It is helpful to determine the extent of invasion of the spinal canal by the displaced fracture block and find the bone or intervertebral disc protruding into the spinal canal.

3.MRI examination

It is extremely valuable for judging the status of spinal cord injury. MRI can show edema and hemorrhage in the early stage of spinal cord injury; there can be symptoms of spinal cord compression, spinal contusion, spinal cord transection, etc .; it can show various pathological changes after spinal cord injury, such as spinal cord contusion, necrosis, cavity, atrophy and glial hyperplasia, etc. .

The significance of MRI for spinal cord injury has the following three aspects:

(1) Factors and locations showing compression of the spinal cord;

(2) shows the degree of spinal stenosis;

(3) Showing changes in spinal cord injury: There are three types of MRI manifestations of acute spinal cord injury: A. bleeding. B. Edema type, C. Mixed type. Edema type injuries are lighter and have a higher recovery rate. Old spinal cord injury: The histological changes of the spinal cord injury are different in the MRI. The spinal cord has a different cyst, and the MRI also shows the cystic cavity. Necrosis in the spinal cord is softened, and glial tissue is loose. In patients with glial and softened internal white matter tissue, MRI is a signal of uneven spots; in patients with spinal cord ischemic glial atrophy, MRI is slightly higher than normal, but thinner than normal spinal cord. MRI judges the degree of spinal cord injury and evaluates the prognosis. The combination of clinical neurology and evoked potentials and MRI examinations has the most reference and guiding significance.

4. Electrophysiological examination

Such as somatosensory evoked potentials, motor evoked potentials, etc., you can understand the functional status of the spinal cord. Somatosensory evoked potential is a test method for measuring the conduction function of spinal cord sensory channels (mainly posterior spinal cord), and motor evoked potential examination represents the function of pyramidal tract motor channels.

5. Jugular vein compression test and myelography

The jugular vein compression test has certain reference significance for judging spinal cord injury and compression. Myelography is meaningful for the diagnosis of old traumatic spinal stenosis.

Spinal and spinal cord injury diagnosis

Diagnosis can be made based on the etiology, clinical manifestations, and imaging studies.

Spinal and Spinal Cord Injury Treatment

1. Spinal cord and spinal cord injury treatment principles

Brake as soon as possible, properly carry and transfer, and reduce secondary spinal cord injury. Life-saving first, then function, that is, life-threatening injuries are treated first, and spinal injuries are stabilized after vital signs stabilize. Without spinal cord injury, conservative treatment is generally available; unstable spinal injury and spinal cord injury are generally treated with surgery. Surgery fully relieved nerve compression and reasonably reconstructed spinal stability. Early rehabilitation creates a suitable internal and external environment for nerve repair, promotes functional recovery, reduces complications, and enables patients to return to society as soon as possible.

(1) Early treatment According to the Advanced Trauma Life Support System (ATLS1), trauma that affects respiratory and circulatory functions must be treated first, and spinal injury assessment is usually second. Preventive measures, including the use of wooden boards and overall roll techniques (shoulder, pelvis, lower extremity, head), should be used routinely throughout the process of moving the injured person from the injury site to the emergency room and imaging department until subsequent spinal injuries Until the diagnosis or elimination process is completed.

(2) Injury assessment Even for unconscious patients, injury assessment is very important. The assessment should include detailed clinical examination and the use of reasonable imaging tools. Patients suspected of having spinal cord and spinal cord injury should be given a rapid examination in the trauma assessment area. A series of observations include: inspection and palpation of the entire spine, recording of skin conditions, flexibility, access volume, mental state, movement and sensory examination of the limbs, digital rectal examination, presence or absence of spinal reflexes.

(3) Early treatment According to the pathological characteristics of spinal cord injury, the treatment should be as early as possible, 6 hours after the injury is the golden period, and 24 hours is the acute period.

(4) Rehabilitation of fracture and dislocation Decompress the spinal cord and stabilize the spine. A fractured block or dislocated vertebra compresses the spinal cord, and the fracture and dislocation should be restored as soon as possible to restore the sagittal diameter of the spinal canal. If a vertebral fracture block, posterior superior vertebral body or disc herniation compresses the spinal cord, anterior decompression is required to stabilize the spine.

(5) Spinal cord injury Due to spinal cord injury, hemorrhage, edema and many secondary injury changes, treatment is needed to obtain recovery opportunities. Use high-dose methylprednisolone in patients with neurological deficits to improve prognosis (except for patients with penetrating injuries). If it can be administered within 3 hours after spinal cord injury, it is recommended to give a rapid bolus of methylprednisolone at a dose of 30 mg / kg, which is completed within 15 minutes, and then a dose of 5.4 mg / kg / h is continued for 23 hours; Dosing is continued for up to 8 hours for 48 hours; if it exceeds 8 hours after injury, methylprednisolone should not be used. Gangliosides are suggested as a potential strategy to improve efficacy. Other drugs including naloxone, thyroid-stimulating hormone-releasing hormone, and erythropoietin have not been confirmed in clinical trials. Hypotension and hypoxia should be avoided. Maintaining an average arterial pressure greater than 90 mmHg is conducive to better recovery of nerve function.

(6) Prevention and treatment of complications including complications of the respiratory system, urinary system and pressure ulcers.

(7) Functional reconstruction and rehabilitation Mainly functional reconstruction of paraplegic hands and upper limbs and reconstruction of urination function.

2.Treatment principles of lower cervical spine injury

(1) First aid Because the injured person's stress points are mostly on the top of the head, sometimes the patient may have a coma. The scene should first consider whether there is a combined injury of the brain and other important organs. Pay attention to the reasonable protection of the neck during transportation to avoid further damage.

(2) Keep the airway open, especially those with complete spinal cord injury above the cervical vertebrae 6 are more likely to have difficulty breathing or even respiratory failure due to respiratory muscle paralysis. If necessary, tracheotomy should be performed as early as possible and mechanically assisted breathing.

(3) Cervical spine fixation is the main method for treating many cervical spine injuries. The most commonly used braces include soft neck braces, two-flap hard neck braces, sternal pillow mandible fixation, and headband vest. The brace type has a better fixation effect.

(4) Surgical treatment Most cervical spine injuries that do not destroy the structural integrity of the spine require surgical treatment. According to the three-pillar model of the spine, damage to a single column without neurological dysfunction is usually stable, and there will be no progressive deformities, neurological impairment or post-traumatic pain. Generally good after using external fixation. Injuries involving three columns, even without neurological dysfunction (rare), are generally considered unstable and require surgery. Injuries involving the second column are also considered unstable and tend to be treated surgically. But some of these injuries can also be treated by braking. Therefore, whether a patient with a two-column injury is operated or not, the neurological status of the patient is often used as a decisive factor. Patients with incomplete or complete injury are usually treated with surgery. However, external fixation can be used in patients with normal neurological examinations or who may have only a single nerve root injury. Other injuries, complications, congenital deformities and degenerative changes can affect the effectiveness of treatment.

(5) Timing of surgery There is no clear view on the surgical decompression and surgical effects of cervical spinal cord injury. It is generally believed that decompression surgery within 24 hours of injury is relatively safe. Patients with progressively worsening neurological function after spinal cord injury are also recommended for early surgical treatment. Early surgery did not significantly increase the incidence of complications in patients with spinal cord injury.

(6) Surgical approach Surgical treatment can be anterior, posterior, or anterior-posterior. For the same patient, there are many surgical methods. The simplest and most direct strategy is based on the area with the most severe structural damage. For an injury that requires reconstruction of the anterior column support structure, anterior surgery is performed; for posterior injury, a direct reduction of the dislocated structure is required, and posterior surgery is performed.

3.Treatment principles of thoracolumbar spine injury

(1) First aid For patients with multiple injuries, thoracolumbar injuries should be identified after life-threatening injuries have been addressed. For patients with suspicious spinal and spinal cord injuries, spinal brakes should be given at the scene. During the patient's handling and transfer, at least three people should complete the transfer and use the correct methods such as translation and axial flip to quickly transfer them.

(2) Injury assessment As high as 11% of patients with multiple injuries, neck injuries are often accompanied by thoracolumbar injuries, which implies that the entire spine must be evaluated to determine a segmental fracture. For patients with high-risk injury mechanisms, stretch injury, neurological deficits, back pain or tenderness, cognitive impairment, and confirmed cervical spine fractures, further imaging examinations of the thoracolumbar spine, such as X-rays and CT, should be performed.

(3) Whether surgical treatment The treatment of thoracolumbar fractures mainly depends on the neurological status of the patient, whether to restore the functional integrity of the spine on the basis of the special injury structure, and the type and severity of existing deformities. Thoracolumbar spine injury classification and severity score (TLICS) is a very useful tool for patients who expect to benefit from surgery. Patients with stable neurologically complete fractures generally do not require surgery. For patients with progressively worsening malformations and sagittal or coronal imbalances, surgery is usually required, while local malformations are generally not required. Patients with spinal, cone, or horsetail injuries are usually treated surgically. Although surgical decompression has an unpredictable effect on the recovery of neurological function in patients with complete paraplegia, it can play a role in reducing the chance of later complications such as syringomyelia. For patients with incomplete neurological deficits, spinal canal decompression can enhance neural recovery potential.

(4) Surgical plan If surgical treatment is considered, anterior, posterior or combined application should be selected based on fracture classification and patient's neurological symptoms. The optimal surgical procedure for thoracolumbar fractures remains controversial. The surgical methods include anterior decompression fusion, posterior decompression fusion, posterior fusion non-decompression, anterior decompression and 360 ° fusion, posterior internal fixation and fusion, posterior fusion and posterior or translumbar fusion Reconstruction of anterior and mid column, posterior fusion, and vertebral cementation. For patients with partially impaired neurological function, different decompression and fusion methods have no significant difference in nerve recovery, and the average postoperative increase is a Frankel level.

Recently, minimally invasive surgery is also emerging. Minimally invasive techniques include anterior endoscopic decompression and internal fixation, posterior percutaneous fusion, the use of temporary spinal external fixators, and percutaneous kyphoplasty. In recent years, kyphoplasty has achieved good results in the treatment of osteoporotic compression fractures. It is also used in patients with traumatic fractures and can also be used with traditional posterior internal fixation surgery.

(5) Surgical approach The principle of surgical approach selection: according to the patient's posterior ligament complex and nerve function status, medical equipment and technical conditions, from simple to complex, as far as possible to complete the surgery under a single approach. For patients with anterior spinal cord syndrome, anterior approach is preferred in most cases. Under certain conditions, such as posterior epidural hematoma, posterior nerve compression, or anterior contraindications, posterior decompression can be substituted, although technically more demanding. Anterior surgery can simultaneously perform decompression, reduction, bone grafting, and internal fixation for fractures. It also has the advantages of short segment fixation and the prevention of postoperative spinal kyphosis by reconstructing the anterior column support structure, but compared with the posterior approach There are also disadvantages of large blood loss and many respiratory complications. The posterior approach is directly exposed, avoiding important structures often encountered in the anterior approach, especially in the upper thoracic and lower lumbar regions, which can provide a good reduction effect for separating spinal injuries. Indications for posterior surgery include complete neurological dysfunction regardless of whether the posterior longitudinal ligament complex (PLC) is intact, dislocations due to separation and rotational violence, and intact or broken nerve roots without PLC or neurological dysfunction.

(6) Timing of surgery When incomplete spinal cord and cauda equina injuries are progressively exacerbated, emergency surgery is required. Patients with spinal cord and cauda equina injury should be treated as soon as possible within 48 hours. There is no spinal cord and cauda equina injury, and if conditions permit, surgical treatment should be performed as soon as possible.