Diagnosis and treatment tactics of specialized medical care provided for patients with spinal disorders at an emergency unit of spinal surgery
Objective To substantiate and evaluate differentiated algorithms of diagnosis and treatment tactics of emergency specialized medical care provided for patients with spinal diseases at a surgical department. Material and methods The review included 1336 patients with degenerative, tumour metastatic and infection non-specific spinal diseases. An index group consisted of 865 patients who received treatment at specialized municipal centre for emergency spinal surgery; control group included 471 patients who received treatment at multidisciplinary municipal hospitals (р > 0.05). Results Parameters of neurological status and spondylogenic abscess with systemic inflammatory response syndrome were primary selection criteria for treatment tactics employed for all types of nontraumatic spinal pathology. In absence of indications to emergency surgical intervention the choice of treatment tactics relied on evaluation of vertebral column instability or potential risk of instability identifying indications to delayed surgical treatment. Emergency interventions were indicated for spinal tumours and infections, while spinal degenerative diseases required delayed and elective surgery. Conclusion Multilevel syndrome-based approach is suggested to determine the tactics of emergency diagnostic search and emergency specialized medical care. The combination and types of pathological syndromes of the first and second orders decide on specific content of diagnostic and therapeutic measures to be taken.