Abstract
We studied neurological outcome to determine the clinical significance of early decompression in cervical cord injury. We treated 35 patients with cervical cord injury by dislocation reduction or removal of bone fragments in the spinal canal. Of these, 20 had incomplete paralysis (Frankel grade B 8, C 10, D 2) at injury (Group IC), and none had neurological aggravation and 17 improved with one or two grades 1 year after injury. Recovery (Yale Scale Score) was 44.1±30.0%. Correlating significantly and negatively with time until decompression (R=-0.727, p=0.0003). In 11 patients, decompression was achieved within 6 hours of injury. In 9, decompression was conducted ten hours after injury or later. Recovery in early decompression (64.0±20.4%) was higher than that in late decompression (19.8±20.4%) (p=0.0004). Some 15 patients were completely paralyzed at injury (Group C). In final follow-up, 8 rated Frankel A, 5 B, 1 C, and 1 D. Their recovery was 11±20%, independent of time until decompression (R=-0.390, p=0.151). In these 15, bulbocavernous reflex (BCR) was positive in 8 and negative in 7 at decompression. Neurological improvement was observed in 2 with positive BCR and in 5 with negative BCR. In these 5, neurological improvement may be merely recovery from spinal shock. Our results suggest that when the patient has incomplete paralysis at injury, early decompression, especially within 6 hours, provides the chance for neurological recovery. Most patients scoring Frankel A at injury, however, had poor results with early decompression. These may include those with incomplete spinal cord injury (i.e., potential recovery) in spinal shock as our BCR study indicated. All spinal cord injury patients should therefore be treated clinically as incomplete paralysis even if they score Frankel A in the acute stage.
