Efficacy of surgical decompression in regard to motor recovery in the setting of conus medullaris injury.
OBJECTIVE
An assessment of neurological improvement after surgical intervention in the setting of traumatic conus medullaris injury (CMI).


METHODS
A retrospective evaluation of a cohort of patients with a blunt traumatic CMI from T12 to L1. The neurologic and functional outcomes were recorded from the acute hospital admission to the most recent follow-up. Data collected included age, level of injury, neurologic examination according to the Frankel grading system and motor index score, and the mechanism and timing of CMI decompression.


RESULTS
A total of 24 patients with a mean age of 27 years (men, 87%) were identified. The most common level of bony injury was L1, and the most frequent mechanism of injury was a motor vehicle crash. Before surgical intervention, 16 of 24 patients (66.7%) had a complete neurological deficit below the level of injury. The median interval from injury to surgery was 6 days (range, 7 hours to 390 days). Decompression, fusion, and adjunctive internal fixation were the most common surgical procedures. Median length of follow-up was 32 months after surgery. Improvement in spinal cord and bladder function was seen in 41.6% and 63.6% of patients, respectively. Root recovery was seen in 83.3% of patients.


CONCLUSIONS
In the setting of CMI, no correlation between the timing of surgical decompression and motor improvement was identified. Root recovery was more predictable than spinal cord and bladder recovery.
Department of Neurosurgery, Khatam-ol-anbia Hospital, Zahedan University of Medical Sciences, Zahedan 98157, Iran. v_rahimi@yahoo.com
Vafa
V
Rahimi-Movaghar
Alexander R
AR
Vaccaro
Mehdi
M
Mohammadi
D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D019299:Decompression, Surgical; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000293:injuries / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology*; D018482:Muscle, Skeletal / Q000294:innervation; D009460:Neurologic Examination; D017288:Pain Threshold / Q000502:physiology; D011379:Prognosis; D020127:Recovery of Function; D012189:Retrospective Studies; D013116:Spinal Cord / Q000503:physiopathology / Q000601:surgery; D013117:Spinal Cord Compression / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013119:Spinal Cord Injuries / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D013126:Spinal Nerve Roots / Q000293:injuries / Q000503:physiopathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000293:injuries / Q000601:surgery; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*