The Efficacy of Non-Operative and Operative Intervention in Regards to Motor Recovery in the Setting of Cervical Spinal Cord Injury
Rahimi-Movaghar, Vafa, Vaccaro, Alexander R., Mohammadi, Mehdi, Iranian Journal of Psychiatry
Objective: An assessment of nonoperative and operative intervention in regards to neurological improvement following traumatic closed cervical spinal cord injury (CSCI).
Method: A retrospective evaluation of a cohort of patients with a CSCI from C3 to T1 was reviewed. The analysis included a total of 13 eligible patients. The neurologic and functional outcomes were recorded from the acute hospital admission to the most recent follow-up. Data included patients' age; level of injury, neurologic exam according to the Frankel grading system, the performance of surgery, the mechanism and timing of the CSCI decompression, and motor index score (MIS).
Results: Ninety-two percent of the patients were male with the mean age of 28.2 ± 11.5. Before treatment, 10/13 patients (77.0%) had functionally complete neurological deficits below the level of injury. The median interval from injury to surgery was 16 days. Eight patients underwent surgical intervention and five were treated nonoperatively. The median length of follow-up was 14 months after surgery (Range: 7 - 93 months). Spinal cord functional improvement was observed in 2/8 (25%) of the surgically managed patients and in 4/5 (80%) of the patients treated nonoperatively. Root recovery was observed in 6/8 (75%) of the patients who were treated surgically and 4/5 (80%) of the patients treated nonoperatively.
Conclusion: Some degree of motor score improvement occurs following a closed cervical spinal cord injury with or without operative surgery in the follow up period.
Key words: Cervical, Decompression, Spinal cord injury, Surgery
Iran J Psychiatry 2009; 4: 131-136
The role and timing of surgical decompression after an acute spinal cord injury (SCI) remains one of the most controversial topics pertaining to spinal surgery (1-5). Blunt spinal trauma complicated by injury to the cervical spinal cord most frequently occurs in young male patients (6, 7). Lack of controlled, prospective, multicenter clinical studies has contributed to confusion in optimal treatment methods for patients with injuries of the cervical spinal cord. The cervical spinal cord is vulnerable to injuries caused by highenergy motor vehicle collisions and falls (8 - 11). Tator et al., showed that agreement among experienced trauma centers is inconsistent with regards to the type and timing of treatment in cervical spine injuries associated with a neurologic deficit. 23.5% of surgeons surveyed operated on cervical spinal cord injury patients within 24 hours postinjury, 15.8% operated between 25 and 48 hours postinjury, 19% between 48 and 96 hours, 41.7% chose to intervene surgically more than 5 days postinjury (12).
The formulation of a treatment plan for patients with injuries to the cervical spinal cord depends on the presence and extent of neurologic injury and existing spinal stability. Both nonsurgical and surgical treatment options are available to achieve the goals of preservation of neurologic function and restoration of spinal stability (7). To date, the role of decompression in patients with incomplete SCI is only supported by Class III and limited Class II evidence (7, 13). Due to the absence of scientific literature examining injuries specific to the cervical spinal cord, a retrospective pilot study was undertaken to access the efficacy and potential morbidities related to the surgical management (decompression and stabilization) of these injuries. This investigation will serve as a foundation for future prospective multicenter studies evaluating the safety and efficacy of surgical intervention in neurologically and mechanically unstable injuries to the cervical spinal cord.
Materials and Method
Between October 1994 and March 2005 a total of 108 patients with a blunt traumatic spinal cord injury were identified at a regional level I trauma in southeastern Iran. Of these patients a subset was identified in which: 1) a neurological deficit was attributable to a traumatic cervical spinal cord injury between C3 to T1; 2) follow-up was a minimum of 6 months; and 3) the cervical spinal cord injury was due to an acute non penetrating traumatic event with radiographically documented cord compression due to cord encroachment by anterior vertebral body elements, disk material, or posterior vertebral elements as a result of a fracture subluxation or dislocation . …