The surgical treatment of acute spinal paralysed patients

Abstract

Following the basic principles of Sir Ludwig Guttmann in respect of the comprehensive care and management of spinal cord injured patients, the German SCI centers try to admit those freshly injured preferably on the first day of onset, providing spinal surgery and intensive care. In our series of recent comprehensive spinal paralysed patients admitted from Jan 1st 1993 to Dec 31st 1995 178 patients requested operative decompression and stabilization out of a total of 255 patients. 51.4% of the patients had been operated within the first 24 h, but 10.5% later than 2 weeks. A high incidence of reoperations (45.2%) must be noted in cases operated prior to the admittance to the SCI center due to failures of instrumentation or lack of anterior reconstruction. Nineteen patients with various spinal tumors underwent surgical treatment, and seven patients with spondylitis and severe neurological deficit. Only 64.4% of the 1st day admissions came in time for administration of high dose methylprednisolone according to the NASCIS II study. The additional pelvic and long bone fractures were operated on following the principles of the Swiss AO, thus achieving immediate mobilization as was also possible after surgical spine stabilization. Neurological recovery could only be found in those with incomplete lesions in more than 50% but also two with neurological deterioration had to be accepted in the paraplegic cohort. Eight who were tetraplegic and 14 with paraplegia died within the first 3 months, but nine with paraplegia had a tumor or spondylitis.

Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach

“…The only therapeutic window established in humans, actually, is the 8-h trauma-to-treatment window reported in the NASCIS-2 in which methyl-prednisolone was used. [11][12][13] The limit of 24 h has been used in this study for two practical reasons: (1) very few reports provide data on an earlier treatment; (2) less than 50% of patients can be currently admitted to spinal cord centres within 24 h. 57,58 Analysis of results and limitations of the study The meta-analytic procedure consisted of extraction, pooling and statistical analysis of data from parent studies. Since only one prospective randomized (Class I evidence) 39 and eight prospective nonrandomized case series (Class II evidence) 32,34,40,[41][42][43][44][45] were found from the literature search, the meta-analysis was based on studies reported on retrospective case series with historical controls (Class III evidence).…”

Neurological outcome in surgically treated patients with incomplete closed traumatic cervical spinal cord injury

“…The advances in spinal stabilization in the last two decades have provided better stability of the bony architecture, hence preventing further instability. 10,11 There is also controversy about early mobilization of the cervical spine injured group. Early mobilization in this group was thought to have worse outcomes on the neurology.…”

Primary osteosarcoma of the thoracic spine: report of an unusual elderly patient with autopsy findings

“…11 In the presence of complete paralysis before the operation, surgical treatment does not produce any essential improvement apart from pain relief, however, neurological improvement tends to be provided by immediate decompression in case of paresis. 12,13 Accordingly, in our case, the patient showed improvement of neurological deficits, although he underwent operation 1 week after the onset of paresis. Thus, these results confirm that early diagnosis is important for better neurological improvement in patients with paresis caused by tumor-related spinal cord compression.…”