Outcome after vertebral fractures with neurological lesion treated either surgically or conservatively in Spain

Traumatic Spinal Cord Injury: Long-Term Motor, Sensory, and Urinary Outcomes

Study Design

Retrospective study.

Purpose

To evaluate how motor, sensory, and urinary outcomes of spinal cord injury (SCI) patients were influenced in the long term.

Overview of Literature

SCI is a potentially disabling and devastating neurological outcome that can occur because of spinal column fractures. Most studies have not evaluated or have failed to show the influence of different surgical approaches and other parameters on neurological recovery.

Methods

A thorough history regarding sensory, motor, and urinary complaints was taken from 103 patients with SCI due to vertebral fracture; patients were followed by a thorough neurological examination. Subsequently, all medical records of patients, including neurological state after trauma, trauma mechanism, treatment protocol, surgical protocol, and imaging findings, were evaluated.

Results

Of the 103 patients, 73.8% were survivors of a major earthquake and 26.2% were victims of vehicle accidents; 92.2% patients were surgically treated, while 7.8% underwent conservative management. The mean follow-up duration was 10.3 years. In follow-up visits, 67.0%, 12.6%, 13.6%, and 6.8% patients showed no, partial, substantial, and complete motor improvement, respectively; 68.0%, 26.2%, and 5.8% showed no, mild, and substantial sensory improvement, respectively; and 73.8%, 17.5%, and 8.7% showed no, substantial, and complete urinary improvement, respectively. Logistic regression analysis showed that sex, age at injury time, follow-up duration, trauma mechanism, and stem cell therapy had no effect on motor, sensory, and urinary improvement. Higher initial scores on the American Spinal Injury Association (ASIA) classification, lumbar fracture level, and performance of laminectomy improved motor outcome; higher initial ASIA scores improved urinary and sensory outcomes.

Conclusions

The initial ASIA score is the most important factor for prognosticating motor, sensory, and urinary improvement in SCI patients. Lumbar (L3–L5) and thoracic (T1–T10) fractures have the best and worst prognosis, respectively, in terms of motor recovery. Laminectomy during surgery improves motor function.

Traumatic spinal cord injury in Saudi Arabia: a review of the literature

Traumatic Spinal Cord Injury (TSCI) is a condition where the neural elements suffer acute trauma, resulting in short-term or permanent sensory and motor problems. An understanding the underlying structural and functional biological repairs of the TSCI mechanisms has intensely increased over the last two decades. However, compared with the other fields in medicine, the present degree of treatment and care for TSCI are quite unsatisfactory. The Kingdom of Saudi Arabia (KSA), the largest country in the Middle East, occupies nearly four-fifths of the Arabian Peninsula with a population of over 28 million. It also has the distinction of having one of the highest rates of spinal cord injuries in the world. However, research on TSCI has been very limited. Therefore, studies on the long-term incidence of TSCI in Saudi Arabia are vital and most essential to identify the high-risk groups, create awareness, establish trends, predict the needs, and thus contribute to effective health care planning of this condition. In this review, we discuss various aspects of TSCI in Saudi Arabia from the available literature.

[Medical treatment of spinal cord injury in the acute stage]

OBJECTIVES

To evaluate the effect on neurologic outcome and the safety of nimodipine (N), methylprednisolone (M), or both (MN) versus no medical treatment (P) in spinal cord injury at the acute phase.

STUDY DESIGN

Prospective, randomized clinical trial.

PATIENTS

One hundred and six patients with a spinal trauma, including 48 with paraplegia and 58 with tetraplegia.

METHOD

After eligibility, patients were randomly allocated in one of the following groups: M = methylprednisolone 30 mg.kg-1 over 1 hour, followed by 5.4 mg.kg-1.h-1 for 23 hours, N = nimodipine 0.015 mg.kg-1.h-1 over 2 hours followed by 0.03 mg.kg-1.h-1 for 7 days, MN or P. Neurologic assessment (ASIA score) was performed by a senior neurologist before treatment and at the 1-year follow-up. Early spinal decompression and stabilization was performed as soon as possible after injury.

RESULTS

One hundred patients were reassessed at the 1-year follow-up. Neurologic improvement was seen in each group (P < 0.0001), however no neurologic benefit from treatment was observed. Infectious complications occurred more often in patients treated with M. Early surgery (49 patients), within the first 8 hours did not influence the neurologic outcome. The only predictor of the latter was the extent of the spinal injury (complete or incomplete lesion).

CONCLUSION

Currently, no evidence of the benefit of medical treatment in this indication is existing. Because of the lack of clinical studies proving efficacy of pharmacological treatment in this specific pathology, a systematic use of medications cannot be recommended.