Periodical, neurological-functional assessment for cervical cord injury.
The residual, reversible potentials of neurological-functional recovery in patients paralysed due to a cervical cord injury were periodically checked according to the various assessment methods from the initial period of 72 hours after injury to the final follow-up of 7 years. In our series, the data on the neurological changes were a little different from those reported in the literature. In the complete paralysis group, only 2 of the 30 patients showed slight functional recovery of less than 1 grade in the Frankel classification with descent of the cord lesion level. Twenty three patients showed descent of a half to one segment from the initial cord lesion level. The remaining 5 patients deteriorated because of ascent of a half to two segments from the initial cord lesion level. All patients with complete paralysis remained essentially unchanged. In the incomplete group, 58 of the 70 patients had significant recovery of more than 1 grade in the Frankel classification. The grade of neurological recovery was different in each patient. Patients with a central cord lesion showed remarkably better recovery of the cord function than those with other types of cord lesions. Nineteen of the 49 patients with a central cord lesion regained independent walking ability with or without aid. Neurological recovery in the incomplete paralysis group might be expected until approximately 6 months after injury. The early appearance of signs of recovery was an indication of better results. There was no difference in the neurological recovery between patients who had been realigned surgically and those who have been realigned non-surgically. Our neurological-functional assessment method reflecting the sectional and logitudinal cord level function and expressing more detailed information was demonstrated. Magnetic resonance imaging (MRI) was used to assess residual cord function. The area of abnormal signal intensity almost corresponded to the cord level diagnosed neurologically.
Department of Orthopaedic Surgery, Shimane Prefectural Central Hospital, Izumo City, Japan.
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Tominaga
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck; D009460:Neurologic Examination; D010243:Paralysis / Q000145:classification / Q000209:etiology / Q000503:physiopathology; D011859:Radiography; D013119:Spinal Cord Injuries / Q000145:classification / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013997:Time Factors