The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis.

摘要

STUDY DESIGN: A prospective study was conducted in 37 patients with cervical spondylosis with incomplete cord injury to assess the role of decompression in these patients. OBJECTIVES: To evaluate surgical and nonsurgical outcomes in patients with pre-existing cervical spondylosis of the spine, in whom an incomplete spinal cord syndrome developed after a minor neck injury. SUMMARY OF BACKGROUND DATA: The benefits of surgical treatment of incomplete cord injury with cervical spondylosis is controversial but remains a treatment option. The results of this study clarified the benefits of surgery in such patients. METHODS: Radiographic findings and outcomes based on post-spinal injury motor function score were compared retrospectively in 37 patients with cervical spondylosis. Sixteen patients were treated operatively and 21 were treated nonoperatively. RESULTS: The neurologic conditions of 13 of the 16 patients (81.2%) treated surgically improved within 2 days of surgery. Comparing the improvement of the two groups at defined intervals, there were statistically significant differences (P < 0.006) between the surgical and nonsurgical patients at 1-month and 6-month follow-ups. Nevertheless, 13 of the 21 patients (62%) treated nonoperatively had recovered to at least muscle Grade 3 at the 2-year follow-up, but their recovery was slower than that of the surgical group. CONCLUSION: Although neurologic improvement after an incomplete spinal cord injury when no bony lesion was present was slow during the first few months after trauma, more than 60% of the patients showed neurologic recovery with a muscle grade higher than 3 at 2-year follow-up. Surgical decompression, however, was associated with immediate neurologic improvement, faster recovery of neurologic function, early mobilization, better long-term neurologic outcome, briefer hospital stays, and fewer complications related to long confinements in bed than was nonoperative treatment.