Nerve root recovery in complete injuries of the cervical spine.
Thirty-six patients with complete quadriplegia were reviewed. Twenty-two underwent surgery, and 14 did not. There were 11 burst fractures and 3 extension fracture-dislocations, which were treated with anterior decompression and rigid plate fixation. There were 22 flexion injuries that were treated with posterior stabilization using Kirschner-wire tension band fixation, Harrington compression hooks, or Halifax laminar hooks. The non-operative group was treated with skeletal traction with skull tongs for 6-12 weeks followed by the application of a hard collar or halo vest for 3 months. Of the 22 patients who underwent surgery, 32% descended one level and 18% two levels. In the nonoperative group, only one patient descended one level. It is concluded that the heretofore pessimistic outlook regarding complete quadriplegia is unwarranted and that a more aggressive approach may result in a better functional outcome.
Yablon
I G
IG
Department of Orthopedic Surgery, University Hospital, Boston, Massachusetts.
Palumbo
M
M
Spatz
E
E
Mortara
R
R
Reed
J
J
Ordia
J
J
D000293:Adolescent; D000328:Adult; D001864:Bone Wires; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries*; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D009068:Movement; D010243:Paralysis / Q000209:etiology / Q000503:physiopathology; D011782:Quadriplegia / Q000209:etiology* / Q000503:physiopathology; D011859:Radiography; D012677:Sensation; D013124:Spinal Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D013126:Spinal Nerve Roots / Q000293:injuries* / Q000503:physiopathology; D014143:Traction; D014945:Wound Healing