Deterioration following spinal cord injury

Abstract

The results are presented of a prospective study of the course of 283 spinal cord-injured patients who were consecutively admitted to five trauma centers participating in the Comprehensive Central Nervous System Injury Centers' program of the National Institutes of Health. Of the 283 patients, 14 deteriorated neurologically during acute hospital management. In 12 of the 14, the decline in neurological function could be associated with a specific management event, and in nine of these 12 the injury involved the cervical cord. Nine of the 14 patients who deteriorated had cervical injuries, three had thoracic cord injuries, and two had thoracolumbar junction injuries. Management intervention was identified as the cause of deterioration in four of 134 patients undergoing operative intervention, in three of 60 with skeletal traction application, in two of 68 with halo vest application, in two of 56 undergoing Stryker frame rotation, and in one of 57 undergoing rotobed rotation. Early surgery on the cervical spine when cord injury is present appears hazardous, since each of the three patients with a cervical cord injury who deteriorated was operated on within the first 5 days. No such deterioration was observed following surgery performed from the 6th day on. In two other patients, deterioration did not appear to be related to management but was a direct product of the underlying disease or of systemic complications. Deterioration following hospitalization for spinal cord injury is relatively uncommon--4.9% in this large series. In most instances, decline in function could be attributed to specific management procedures. These changes must not be interpreted as representing failure to provide optimal care but rather should be seen as the inevitable product of an attempt to manage patients with spinal cord and column injuries, many of which are clearly unstable.

Length of stay and medical stability for spinal cord-injured patients on admission to an inpatient rehabilitation hospital: a comparison between a model SCI trauma center and non-SCI trauma center

“…15 There is conflicting evidence regarding the timing of surgery of SCI patients, and the related complication rate and LOS. Marshall et al 16 reported in 1987 that postoperative neurological deterioration appeared only in cervical SCI patients who were operated early (5 days or less after injury). This report made some surgeons shy away from early surgery in patients with traumatic SCI.…”

Does early decompression improve neurological outcome of spinal cord injured patients? Appraisal of the literature using a meta-analytical approach

“…In acute systemic trauma, there is a greater probability of failure of alignment and fusion, and surgical treatment may be precluded by the lack of specific equipment and experienced personnel. 21,22 Furthermore, definitive and unequivocal evidence to support the practice of early or late surgery are still lacking in clinical studies. 21,[23][24][25][26][27][28][29][30][31][32][33][34][35][36] Recently, in an evidence-based review of the literature, Fehlings and Tator 10 concluded, on the bases of the current knowledge, that early decompression can be considered a practice option.…”

Secondary medulla oblongata involvement following middle cervical spinal cord injury associated with latent traumatic instability in a patient with ossification of the posterior longitudinal ligament

“…1,2 Many reports have documented that hemorrhage, microvascular infarction, spasm, spinal cord edema, and free radical production are relevant factors affecting this serious condition. 7,8 Lu et al 9 reported the predictable risk factors for delayed apnea following middle to lower CSCI in the presence of diffuse and extensive cord lesions, respiratory distress, and bradycardia.…”

“…1,2 Although the mechanism causing spinal deterioration is still unclear, a structural instability in the injured segment is one of the most important factors affecting these detrimental changes. 3 Surgical decompression and fixation of the cervical spine is the recommended treatment in a patient with structural damage, such as a spinal fracture-dislocation.…”