Summary. Facilities providing a co-ordinated 'system' of care to the spinal cord injured are now more accepted as being preferable to fragmented 'non-system' facilities. Data reflecting the incidence of selected complications common to spinal cord injury were collected over a 2-year period from a system located outside the United States and from 'non-systems' within the United States. The latter was defined as care provided in community facilities prior to entry into one of 14 model United States spinal cord injury centres.All complications occurred more frequently in the American group, particularly decubitus ulcers and urinary tract infections.The data suggest that system care is preferable to non-system care in its capacity to prevent costly complications and the sooner the spinal cord injured patient is referred to a spinal cord centre capable of meeting all his needs, the less likely will he be exposed to complications that could slow the rehabilitation effort.
Sixty-one patients with closed cervical spinal cord injury were cared for within a defined protocol and followed for at least 1 year. Neurological recovery and healing of spinal structures were evaluated at intervals. Forty-three patients were managed without surgical intervention at the site of spine trauma, and the incidence of spontaneous fusion ("autofusion") was noted. Surgical fusion was performed on 17 patients, mainly to restore spinal stability and alignment. One patient underwent laminectomy without fusion. In both the surgical fusion and the autofusion groups, there were significant numbers of patients who improved neurologically, including some designated as having a complete spinal cord lesion at the initial neurological examination. As expected, better spinal alignment was achieved in the surgical group, although alignment in the nonsurgically treated group was generally acceptable. The majority of patients developed radiographically apparent callus formation anterior to the injured vertebral bodies, regardless of the mechanism of injury or the method of treatment. After 3 months all patients who underwent surgical fusion achieved spinal stability, as did the majority of patients in the autofusion group. Only individuals with flexion-distraction injuries who did not undergo surgical fusion appeared to be at risk for progressive spinal column deformity. Neither retropulsion of bone fragments nor angulation at the fracture site appeared to correlate with a poor neurological outcome, since improvement in neurological function occurred similarly in patients with and without these deformities.
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