Treatment of patients with spinal cord lesions in Germany 1996--state of the art.

Abstract

Modern treatment of sufferers from spinal cord lesions according to the guidelines elaborated by Sir Ludwig Guttmann in the UK started in specialised centres in Germany some 45 years ago. At the present time the incidence is 18 cases/l million/year traumatic and non traumatic. Exact figures are available since 20 years ago. Twenty-one appropriate centres with altogether 1071 beds are able to admit almost all traumatic cases and 30% of non traumatic cases for 'comprehensive treatment'. That includes cervical lesions above C4 as well as patients with polytrauma, intensive care, spinal column surgery, sophisticated urological diagnostic and treatment, physio- and occupational therapy, psychological and social assistance. To fulfill all tasks arising from lifetime care and readmissions there is a need of another 800 beds in specialised centres not dealing with recent cases. The original principle to offer first treatment and life-time follow up 'under one roof' is to be given up as conservative treatment of the broken spine has been continually replaced by spinal surgery done in non specialised primary admitting regional hospitals. Priority is given to the aim to offer similar opportunities to everyone by providing 800 additional beds in new specialised centres.