Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia.
METHODS
Retrospective review of 412 patients with traumatic, incomplete, cervical spinal cord injuries, and an average follow-up period of 2 years.


OBJECTIVE
To determine what patient characteristics, injury variables, and management strategies are associated with improved neurologic outcomes. In particular, the effects of intravenous steroids (NASCIS II protocol), early definitive surgery (<24 hours after injury), early anterior decompression for burst fractures or disc herniations (<24 hours after injury), and surgical decompression for stenosis without fracture were assessed.


BACKGROUND
Controversy surrounds the pharmacologic and surgical management of patients with spinal cord injuries.


METHODS
Neurologic data were collected retrospectively and classified using American Spinal Injury Association guidelines. This information was recorded at the time of injury, on admission to rehabilitation, on discharge from rehabilitation, and at 1, 2, and final year of follow-up evaluation. Outcome measures included change in motor score, change in sensory score, final motor score, and final sensory score. The SPSS v10.0.7 statistical software package was used for data analysis.


RESULTS
Neurologic recovery was not related to the following factors: gender, race, type of fracture, or mechanism of injury. Neurologic recovery also was not related to the following interventions: high-dose methylprednisolone administration, early definitive surgery, early anterior decompression for burst fractures or disc herniations, or decompression of stenotic canals without fracture. Improved neurologic outcomes were, however, noted in younger patients ( = 0.002), and those with either a central cord or Brown-Sequard syndrome ( = 0.019).


CONCLUSIONS
The most important prognostic variable relating to neurologic recovery in a patient with a spinal cord injury is the completeness of the lesion. When an incomplete cervical spinal cord lesion exists, younger patients and those with either a central cord or Brown-Sequard syndrome have a more favorable prognosis for recovery. In this study, no evidence was found to support high-dose steroid administration, routine early surgical intervention, or surgical decompression in stenotic patients without fracture.
Pollard
Matthew E
ME
Department of Orthopaedic Surgery, Atlanta Medical Center, Atlanta, Georgia, USA. matthewandelizabeth@msn.com
Apple
David F
DF
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D018437:Brown-Sequard Syndrome / Q000188:drug therapy / Q000209:etiology / Q000601:surgery; D019299:Decompression, Surgical / Q000009:adverse effects / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D008297:Male; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D019838:Neck Injuries / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D018696:Neuroprotective Agents / Q000627:therapeutic use; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D011782:Quadriplegia / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D020127:Recovery of Function; D012189:Retrospective Studies; D018401:Sample Size; D013119:Spinal Cord Injuries / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D013130:Spinal Stenosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery; D013997:Time Factors; D015599:Trauma Severity Indices
D018696:Neuroprotective Agents; D008775:Methylprednisolone