Enfoque clínico y terapéutico del trauma raquimedular en el segundo nivel de atención

Abstract

Introduction. Spinal cord injury is a devastating pathology that involves all types of traumatic injury that compromises at any level the form elements of the spine generating an impact on the biopsychosocial and economic field of both the patient and the health system. Objective. Clinically differentiate the types of spinal cord injury in spinal cord trauma through semiological knowledge and review of updated literature in order to use the most appropriate and timely treatment applied to daily medical practice. Methodology. A retrospective, descriptive and qualitative study based on the systematic review of high-impact scientific articles from different search engines such as Cochrane, Pubmed, Elsevier, Scielo, Scopus published in the last 5 years was used. Conclusion. Management of spinal cord trauma associated or not with polytrauma should be initiated at the scene of the accident with rapid assessment of neurological integrity, appropriate selective immobilization, and early transfer. Diagnosis should include a complete neurological examination (ASIA scale) and imaging studies; The type of image of choice is computerized axial tomography. The goal in treatment is to preserve residual neurological function, avoid secondary damage, and restore alignment and stability of the spine, highlight the different treatment alternatives: decompressive surgery in less than 24 hours or delayed, methylprednisolone, neuro protection and neuro regeneration. The prognosis of these patients will depend on a timely comprehensive management from the first contact at the prehospital level, to safeguard the residual functional and neurological anatomical integrity of the patient.