ABSTRACT
Thoraco-lumbar (T-L) spine trauma accounts for nearly 30% to 50% of all spine injuries. Most of these injuries occur due to high energy mechanisms and can result in considerable morbidity, because of the ensuing mechanical and/or neurologic instability of the spine, systemic manifestations of spinal cord injury (SCI) and concomitant systemic injuries. Patients with a severe SCI and/ or a complete SCI usually have a more difficulty with the course of treatment. The primary SCI, which occurs at the time of the trauma, is irreversible; but the subsequent secondary SCI, which is typically characterized by cord ischemia and edema, can be therapeutically influenced. Therefore, the management largely focuses on limiting the secondary SCI by measures that restore physiologic homeostasis and an early decompression-stabilization surgery of the spine. The SCI also evolves over time, from an acute phase, which is characterized by physiologic instability , to a more stable but debilitating, chronic phase, which is associated with autonomic hyper-reflexia. Hence, management of patients with T-L spine trauma can be quite challenging for the anesthesiologist. In the initial sections of this chapter, we provide an overview of the fundamental concepts that guide the management of these patients (epidemiology; functional anatomy and biomechanics of the T-L spine; pathophysiologic and clinical consequences of SCI; pertinent surgical considerations); in the latter sections, we describe their initial management in the Emergency Room, and their perioperative anesthetic management when they present for an urgent intervention in the acute phase of SCI or for repeat surgery in the chronic phase of SCI.
