[Importance of early operative decompression of spinal cord after cervical spine injuries].
OBJECTIVE
There is no standard timing of the spinal cord decompression. Experimental animal models and clinical investigations on Methylprednisolone (NASCIS-2 and -3) indicate that the time up to 8 hours is the optimal therapeutic window for the early spinal cord decompression. We accepted this time window in our practice. A retrospective clinical evaluation of the early (up to 8 hours) operative decompression of the injured cervical spinal cord was undertaken.


METHODS
The early operative decompression (range of 2-8 hours) of the cervical spinal cord was done in 32 patients (82% of operated cervical spinal cord injured patients). The neurologic clinical status of patients was assessed according to the ASIA impairment scale. In neurological terms 7 patients were completely and 25 incompletely impaired. Cervical spine injuries included 26 fractures and fracture-dislocations and the rest (6 cases) involved dislocations and disc ruptures. The mean patient age was 31.2 years (range of 16-69) and the average follow-up time was 13 months (range of 6-24). Methylprednisolone standard treatment was applied in all patients on admission to hospital. After diagnostic examinations patients were qualified and immediately operated. We performed 25 corpectomies, 6 discectomies and 1 decompressive laminectomy with stabilization in all cases.


RESULTS
The final assessment covers 29 patients because 3 (9.4%) of them died during 4-6 weeks after operation. One patient has not improved and still had A degree but 28 remaining patients (94.5%) have improved neurologically at follow-up. 69% of them recovered by one degree and 27.6% by two degrees on the ASIA scale. In the early postoperative stage during their hospital stay 47% of patients had one degree improvement.


CONCLUSIONS
The early cervical spinal cord decompression creates optimal conditions for the neurological recovery. Encouraging results presented in the paper indicate the purposefulness of the decompression performed as fast as possible and indicate the necessity to make emergency services more efficient in order to shorten delivery time to specialized spine centers.
Hakało
Jerzy
J
Oddział Neurochirurgii, Szpital Wojewódzki w Zielonej Górze. hakalo@poczta.onet.pl
Wroński
Jerzy
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D002574:Cervical Vertebrae / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage; D008875:Middle Aged; D011044:Poland; D013117:Spinal Cord Compression / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013124:Spinal Injuries / Q000150:complications / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome
D000893:Anti-Inflammatory Agents; D008775:Methylprednisolone