NEUROSURGERY AND CLINICAL IMPLICATIONS OF NEUROLOGICAL SEQUELAE IN ADULTS WITH MULTIPLE TRAUMAS, INCLUDING TRAUMATIC BRAIN INJURY AND SPINAL CORD INJURY: AN INTEGRATIVE REVIEW

Abstract

Introduction: Polytrauma can associate neurological injuries with damage to other systems, making the care of adults with traumatic brain injury (TBI) and/or spinal cord or spinal cord trauma complex. Clinical stabilization, prevention of secondary neurological injuries, and defining the timing of neurosurgical interventions need to consider the patient's overall severity. Objective: To analyze the literature on the neurosurgical management of polytraumatized adults with TBI and/or spinal cord or spinal cord trauma, considering approaches, complications, sequelae, and neurological and functional outcomes. Methods: A qualitative and descriptive narrative review was conducted. Relevant publications on the topic were consulted, including guidelines, consensus statements, clinical and observational studies, and reviews. The synthesis was organized around initial stabilization, management of severe TBI, treatment of spinal cord trauma, and functional outcomes. Results: The sources highlight the importance of hemorrhage control and prevention of hypoxia and hypotension. For acute spinal cord injury, decompression is recommended within 24 hours when clinically feasible, although evidence regarding surgery within 12 hours remains inconclusive. In severe TBI, decompressive craniectomy may reduce mortality in selected patients but does not guarantee functional independence. Studies on concurrent TBI and spinal cord injury identify associations with some less favorable outcomes, without proving causality. The literature also shows variation in the instruments used to assess quality of life, functionality, and social participation. Conclusion: Management should be individualized and coordinated between specialties, balancing stabilization, prevention of secondary injuries, and surgical opportunity. Precise evaluation should include survival and neurological function, as well as independence, mental health, and quality of life. More specific and uniform studies on this population and their long-term outcomes are needed.