Articles

The Efficacy of Non-operative and Operative Intervention in Regards to Motor Recovery in the Setting of Cervical Spinal Cord Injury

Abstract

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.

Fehlings MG, Perrin RG. The Timing of Surgical Intervention in the Treatment of Spinal Cord Injury: A Systematic Review of Recent Clinical Evidence. Spine 2006; 31: S28-S35.

Rahimi-Movaghar V. The Efficacy of Surgical Decompression in the Setting of Complete Thoracic Spinal Cord Injury. J Spinal Cord Med 2005; 28: 415-420.

Rahimi-Movaghar V, Vaccaro AR, Mohammadi M. The Efficacy of Surgical Decompression in Regards to Motor Recovery in the Setting of Conus Medullaris Injury. J Spinal Cord Med 2006; 29: 32-38.

Rahimi-Movaghar V, Mohammadi M, Yazdi A. [Comparison between nonoperative and operative care and timing of surgery in spinal cord injury]. Hakim 2006; 9: 50-57.

Yazdi A, Rahimi-Movaghar V, Karimi M, Mohammadi M. [Effect of immediate decompression in complete spinal cord injury in rats]. Hakim 2006; 8 : 52-59 .

Kiwerski J, Weiss M. Neurological improvement in traumatic injuries of cervical spinal cord. Paraplegia. 1981; 19: 31-37.

Geisler FH, Coleman WP, Grieco G, Poonian D; Sygen Study Group. Recruitment and early treatment in a multicenter study of acute spinal cord injury. Spine 2001; 26: S58-67.

Fehlings MG, Sekhon LH, Tator C. The Role and Timing of Decompression in Acute Spinal Cord Injury: What Do We Know? What Should We Do? Spine 2001; 26: S101–110.

Fehlings MG, Tator CH. An evidence-based review of surgical decompression for acute spinal cord injury: rationale, indications, and timing based on experimental and clinical studies. J Neurosurg 1999; 91: 1–11.

Kraus JF, Franti CE, Riggins RS, Richards D, Borhani NO. Incidence of traumatic spinal cord lesions. J Chronic Dis 1975; 28: 471–492.

Rizzolo SJ, Vaccaro AR, Cotler JM. Cervical spine trauma. Spine 1994; 19: 2288-2298.

Tator CH, Fehlings MG, Thorpe K, Taylor W. Current use and timing of spinal surgery for management of acute spinal surgery for management of acute spinal cord injury in North America: results of a retrospective multicenter study. J Neurosurg 1999; 91: 12-18.

La Rosa G, Conti A, Cardali S, Cacciola F, Tomasello F. Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach. Spinal cord 2004; 42: 503-512.

Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, et al. A randomized controlled trial of methylprednisolone or naloxone in the treatment of acute spinal cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 1990; 322: 1405-1411.

Quencer RM, Sheldon JJ, Post MJ, Diaz RD, Montalvo BM, Green BA, et al. MRI of the chronically injured cervical spinal cord. Am J Roentgenol 1986; 147: 125-132.

Bohlman HH, Anderson PA. Anterior decompression and arthrodesis of the cervical spine: long-term motor improvement. Part 1 – Improvement in incomplete traumatic quadriparesis. J bone Joint Surg 1992; 74: 671-682.

Mirza SK, Krengel WF 3rd, Chapman JR, Anderson PA, Bailey JC, Grady MS, et al. Early versus delayed surgery for acute cervical spinal cord injury. Clin Orthop Relat Res 1999; 359: 104-114.

Vaccaro AR, Daugherty RJ, Sheehan TP, Dante SJ, Cotler JM, Balderston RA, et al. Neurologic outcome of early versus late surgery for cervical spinal cord injury. Spine 1997; 22: 2609-2613.

Wagner FC Jr, Chehrazi B. Early decompression and neurological outcome in acute cervical spinal cord injuries. J Neurosurg 1982; 56: 699-705.

Heiden JS, Weiss MH, Rosenberg AW, Apuzzo ML, Kurze T. Management of cervical spinal cord trauma in southern California. J Neurosurg 1975; 43: 732-736.

Brodkey JS, Richards DE, Blasingame JP, Nulsen FE. Reversible spinal cord trauma in cats. Additive effects of direct pressure and ischemia. J Neurosurg 1972; 37: 591-593.

Carlson GD, Minato Y, Okada A, Gorden CD, Warden KE, Barbeau JM, et al. Early time- dependent decompression for spinal cord injury, vascular mechanisms of recovery. J Neurotrauma 1997; 14: 951-962.

Croft TJ, Brodkey JS, Nulsen FE. Reversible spinal cord trauma: a model for electrical monitoring of spinal cord function. J Neurosurg 1972; 36: 402-406.

Delamarter RB, Sherman J, Carr JB. Pathophysiology of spinal cord injury: recovery after immediate and delayed decompression. J Bone Joint Surg 1995; 77: 1042-1049.

Dolan EJ, Tator CH, Endrenyi L. The value of decompression for acute experimental spinal cord compression injury. J Neurosurg 1980; 53: 749-755.

Guha A, Tator CH, Endrenyi L, Piper I. Decompression of the spinal cord improves recovery after acute experimental spinal cord compression injury. Paraplegia 1987; 25: 324- 339.

Kobrine AI, Evans DE, Rizzoli HV. Correlation of spinal cord blood flow and function in experimental compression. Surg Neurol 1978; 10: 54-59.

Kobrine AI, Evans DE, Rizzoli HV. Experimental balloon compression of the spinal cord: factors affecting disappearance and return of spinal evoked potential. J Neurosurg 1979; 51: 841-845.

Nystrom B, Berglund JE. Spinal cord restitution following compression injuries in rats. Acta Neurol Scand1988; 78: 467-472.

Sekhon LH, Fehlings MG. Epidemiology, Demographics, and Pathophysiology of Acute Spinal Cord Injury . Spine 2001; 26: S2-12.

Chen TY, Dickman CA, Eleraky M, Sonntag VK. The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis. Spine 1998; 22: 2398- 2403.

Duh MS, Shepard MJ, Wilberger JE, Bracken MB. The effectiveness of surgery on the treatment of acute spinal cord injury and its relation to pharmacological treatment. Neurosurgery 1994; 35: 240-249.

Ng WP, Fehlings MG, Cuddy B, Dickman C, Fazl M, Green B, et al. Surgical treatment for acute spinal cord injury study pilot # 2: evaluation of protocol for decompressive surgery within 8 hours of injury. Neurosurg Focus 1999; 6: e3.

Pointillart V, Petitjean ME, Wiart L, Vital JM, Lassié P, Thicoipé M, et al. Pharmacological therapy of spinal cord injury during the acute phase. Spinal Cord 2000; 38: 71-76.

Tator CH, Duncan EG, Edmonds VE, Lapzack LI, Andrews DF. Comparison of surgical and conservative management in 208 patients with acute spinal cord injury. Can J Neurol Sci 1987; 14: 60-69.

Waters RL, Adkins RH, Yakura JS, Sie I. Effect of surgery on motor recovery following traumatic spinal cord injury. Spinal Cord 1996; 34: 188-192.

Waters RL, Meyer PR, Adkins RH, Felton D. Emergency, acute, and surgical management of spine trauma. Arch Phys Med Rehabil 1999; 80: 1383-1390.

Bohlman HH, Freehafer A. Late anterior decompression of spinal cord injuries. J Bone Joint Surg 1975; 57: 10-25.

Frankel H, Hancock D, Hyslop G, Melzak J, Michaelis LS, Ungar GH, et al. The value of postural reduction in the initial management of closed injuries of the spine with paraplegia and tetraplegia. Part 1. Paraplegia 1969; 7:179- 192.

Papadopoulos SM, Selden NR, Quint DJ, Patel N, Gillespie B, Grube S. Immediate spinal cord decompression for cervical spinal cord injury: feasibility and outcome. J Trauma 2002; 52: 323-332.

Levi L, Wolf A, Rigamonti D, Ragheb J, Mirvis S, Robinson WL. Anterior decompression in cervical spine trauma: does timing of surgery affect the outcome? Neurosurgery 1991; 29: 216-222.

Wilmot CB, Hall KM. Evaluation of the acute management of tetraplegia: conservative versus surgical treatment. Paraplegia 1986; 24: 148-153.

Pollard ME, Apple DF. Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia. Spine 2003; 28: 33-39.

Anderson PA, Bohlman HH. Anterior decompression and arthrodesis of the cervical spine: long-term motor improvement. J Bone Joint Surg 1992; 74: 683-692.

Donovan WH, Cifu DX, Schotte DE.Neurological and skeletal outcomes in 113 patients with closed injuries to the cervical spinal cord. Paraplegia 1992; 30: 533-542.

Rahimi-Movaghar V, Saadat S, Vaccaro AR, Ghodsi SM, Samadian M, Sheykhmozaffari A, et al. The efficacy of surgical decompression before 24 hours versus 24 to 72 hours in patients with spinal cord injury from T1 to L1-- with specific consideration on ethics: a randomized controlled trial. Trials 2009 ;10: 77.

Files
IssueVol 4 No 4 (2009) QRcode
SectionArticles
Keywords
Cervical Decompression Spinal cord injury Surgery

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Vaccaro AR, Rahimi-Movaghar V, Mohammadi M. The Efficacy of Non-operative and Operative Intervention in Regards to Motor Recovery in the Setting of Cervical Spinal Cord Injury. Iran J Psychiatry. 1;4(4):131-136.