Yaminskyi Y. Renewing surgical treatment of patients with consequences of traumatic spinal cord injury

The dissertation is devoted to renewing surgical treatment of patients with consequences of spinal cord (SC) traumatic injury. The particularities SC traumatic disease clinical flow depending on severity, terms injury and level were studied. The research is based on results of complex clinical investigation and treatment of 248 patients with consequences of SC traumatic injury been treated .87 patients had injury of cervical, 85 - of thoracic and 76 - of lumbo-sacral spine. All patients were divided into following groups depending on severity of the injury: ASIA А group - 117 patients, ASIA В group - 64, ASIA С group - 55, ASIA D group - 12. In order to improve patients' quality of life following surgical procedures were performed: operations, aimed to improve motions and sensitivity, to adjust neurogenic bladder dysfunction, to reduce neuropathic pain syndrome and spasticity. Besides traditional surgical procedures we developed and introduced into clinical practice new methods of surgical treatment: epidural electrical stimulation of SC injured area in order to improve it's conductivity; reimplantation of nerves of lumbar intumescence in order to form bypasses of spinal innervation; transposition of musculocutaneal nerve branches to median nerve in order to improve wrist and fingers flexion, transposition of obturator nerve branches to femoral nerve in order to restore walking, anode-stimulation of lumbar intumescence in order to reduce spasticity. The efficacy of different methods of surgical treatment depending on severity and terms of trauma was analyzed.Use of modern methods of pre- and inraoperative diagnostics, treatment technique improvement and reconstructive methods of surgical treatment application allowed to renew walking in 11.7% patients, to improve urination control - in 58.9%, to decrease spasticity - in 79.5% and severity of neuropathic pain syndrome - in 80.4%, to improve quality of life of 75.4% of patients.