We analyzed 10 cases who had received surgery for acute injuries of the thoracic spine complicated by paralysis. Of those 10 cases, 4 patients had a complete and remaining 6 had an incomplete lesion of the spinal cord. Of the 4 patients who had a
complete lesion of the spinal cord, significant neurologic function did not recover in 3, regardless of the type and timing of the surgery.
In one of 4 patients who had a complete lesion, there was some improvement of sensation. Of the 6 patients who had an incomplete lesion of the spinal cord, 4 received a surgery within 24 hours of injury, and remaining 2 had surgery on posttrauma
30th
and 35th days respectively. Average neurologic improvement was 1.75 Frankel grades per patient in the early surgery group and was 1 Frankel grade in the delayed surgery group. Of 6 patients with incomplete lesion, 4 were treated with laminectomy
and
fusion with instrumentation, and they improved by average 1.75 Frankel grades. And remaining 2 were treated by laminectomy or anterior transthoracic decompression and fusion respectively and they improved by 1 Frankel grade respectively. Based on
the
results of this study and other references, we suggest that early surgical intervention improves neurologic recovery in comparison to late surgical intervention and that posterior surgical instrumentation is indicated in acute unstable bursting
fracture
and flexion-dislocation injury. Also we suggest that anterior transthoracic decompression and fusion is indicated in cases of neural compression by bone or disc fragments.
|