Abstract
The influence of spine surgery on motor recovery between 1 month and 1 year was assessed prospectively in a group of 269 patients following traumatic spinal cord injury (SCI) using the classification system originally developed by the American Spinal Injury Association. The Allen classification was used to categorize cervical vertebral pathology and the Denis system was used for injuries to the thoracic and lumbar spine. Gunshot injuries were classified based upon the bullet trajectory and location relative to the spinal canal. Individuals undergoing surgery were divided into various subgroups depending on the type of surgery performed: anterior decompression with or without spine fusion and instrumentation, posterior decompression/laminectomy with or without spine fusion and instrumentation and spine fusion with instrumentation. Motor score recovery between 1 month and 1 year after injury was highly dependent (P≤0.001) on the level and completeness of injury averaging 0.7 ± 2.7 for complete paraplegics, 7.8 + 4.8 for complete tetraplegics, 11.8 + 8.3, for incomplete paraplegics and 22.2+10.9 for incomplete tetraplegics. Motor recovery did not significantly differ between patients categorized in various surgical subgroups or between those having surgery and those treated non-operatively. Additionally, although the sample size was small, motor recovery among ttraplgie individuals did not depend on whether unilateral and bilateral facet dislocations were reduced and in patients with incomplete lesions, those with reductions actually had a poorer outcome than those who were left in a dislocated position.
References
Cotler J M, Vernace J V, Michalski J A . The use of Harrington rods in thoracolumbar fractures. Orthopedic Clinics of North America 1986; 17: 87–103.
Cotler H B . The treatment of cervical spine trauma: a century of progress. Orthopaedics 1992; 5: 279–283.
Bradford D S, McBride G G . Surgical management of thoracolumbar spine fractures with incomplete neurological deficits. Clinical Orthopaedics and Related Research 1987: 218: 201.
Bohlman H H, Freehafer A, Dejak J . The results of treatment of acute injuries of the upper thoracic spine with paralysis. JBJS 1985: 67A: 360.
Crutcher J P et al. Indirect spinal canal decompression in patients with thoracolumbar burst fractures treated by posterior distraction rods. J Spinal Dis 1991; 4: 39–48.
Mumford J et al. Thoracolumbar burst fractures: The clinical efficacy and outcome of nonoperative management. Spine 1993; 18: 955–970.
Waters R L et al. Recovery following complete paraplegia. Arch Phys Med Rehabil 1992; 73: 784–789.
Waters R L et al. Motor and sensory recovery following complete tetraplegia. Arch Phys Med Rehabil 1993; 74: 242–247.
Waters R L et al. Motor and sensory recovery following incomplete paraplegia. Arch Phys Med Rehabil 1994; 75: 67–72.
Waters R L et al. Neurologic recovery following incomplete tetraplegia. Arch Phys Med Rehabil 1994; 75: 306–311.
Bracken M B et al. A randomized, controlled trial of methyl-prednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. New Eng J Med 1990; 322: 1405–1411.
Allen B L et al. A mechanistic classification of closed indirect fractures and dislocations of the lower cervical spine. Spine 1982; 7: 1–27.
Denis F . The three column spine and its significance in the classification of acute thoracolumbar spine injuries. Spine 1983; 8: 817–831.
Waters R L et al. Profiles of spinal cord injury and neurologic recovery following gunshot. Clin Orthop 1991; 267: 14–21.
Stover S L, De Lisa J A, Whiteneck G G . Spinal Cord Injury Clinical Outcomes from the Model Systems. Gaithersburg, MD: Aspen Publishers, Inc., 1995.
Standards for Neurological Classification of Spinal Injury Patients. American Spinal Injury Association 1985; Chicago, Illinois.
Ditunno J F . The international standards booklet for neurological and functional classification of spinal cord injury. Paraplegia 1994; 32: 70–80.
Capaul M et al. Analyses of 94 consecutive spinal cord injury patients using ASIA definition and modified Frankel score classification. Paraplegia 1994; 32: 583–587.
Brown P J et al. The 72 h examination as a predictor of recovery in motor complete quadriplegia. Arch Phys Med Rehabil 1991; 72: 546–548.
Waters R L et al. Effect of Injury Pattern on Motor Recovery following Traumatic SCI. Arch Phys Med Rehabil 1995; 76: 440–443.
Waters R L, Adkins R H . The effects of removal of bullet fragments retained in the spinal canal. A collaborative study by the National Spinal Cord Injury Model Systems. Spine 1991; 16: 934–939.
Delamarter R B, Sherman J E, Carr J B . 1991 Volvo Award in Experimental Studies, Cauda Equina Syndrome: Neurologic recovery following immediate, early, or late decompression. Spine 1991; 16: 1022–1029.
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Waters, R., Adkins, R., Yakura, J. et al. Effect of surgery on motor recovery following traumatic spinal cord injury. Spinal Cord 34, 188–192 (1996). https://doi.org/10.1038/sc.1996.37
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DOI: https://doi.org/10.1038/sc.1996.37
Keywords
- spinal cord injury
- motor recovery
- surgical treatment
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