Clinical Analyzed of Thoracic Level Spinal Cord Injured Patients.

Rha, Hyoung Kuin; Ji, Cheol; Choi, Chang Rak

Original Article

Journal of Korean Neurosurgical Society 1994;23(11): 1260-1267.

Hyoung Kuin Rha, Cheol Ji, Chang Rak Choi

Department of Neurosurgery, Catholic University, Medical College, Seoul, Korea.

ABSTRACT

We analyzed 10 cases who had received surgery for acute injuries of the thoracic spine complicated by paralysis. Of those 10 cases, 4 patients had a complete and remaining 6 had an incomplete lesion of the spinal cord. Of the 4 patients who had a complete lesion of the spinal cord, significant neurologic function did not recover in 3, regardless of the type and timing of the surgery. In one of 4 patients who had a complete lesion, there was some improvement of sensation. Of the 6 patients who had an incomplete lesion of the spinal cord, 4 received a surgery within 24 hours of injury, and remaining 2 had surgery on posttrauma 30th and 35th days respectively. Average neurologic improvement was 1.75 Frankel grades per patient in the early surgery group and was 1 Frankel grade in the delayed surgery group. Of 6 patients with incomplete lesion, 4 were treated with laminectomy and fusion with instrumentation, and they improved by average 1.75 Frankel grades. And remaining 2 were treated by laminectomy or anterior transthoracic decompression and fusion respectively and they improved by 1 Frankel grade respectively. Based on the results of this study and other references, we suggest that early surgical intervention improves neurologic recovery in comparison to late surgical intervention and that posterior surgical instrumentation is indicated in acute unstable bursting fracture and flexion-dislocation injury. Also we suggest that anterior transthoracic decompression and fusion is indicated in cases of neural compression by bone or disc fragments.

Key Words: Thoracic spine injury; Incomplete lesion; Laminectomy; Posterior surgical instrumentation; Anterior transthoracic decompression and fusion