Hostname: page-component-745bb68f8f-lrblm Total loading time: 0 Render date: 2025-01-14T13:19:49.472Z Has data issue: false hasContentIssue false
  • English
  • Français

Comparison of Surgical and Conservative Management in 208 Patients with Acute Spinal Cord Injury

Published online by Cambridge University Press:  18 September 2015

C.H. Tator ,
E.G. Duncan ,
V.E. Edmonds ,
L.I. Lapczak  and
D.F. Andrews
C.H. Tator*
Affiliation:
Spinal Cord Injury Treatment, Research and Prevention Centre, Toronto Western Hospital and Department of Statistics, University of Toronto, Toronto, Ontario
E.G. Duncan
Affiliation:
Spinal Cord Injury Treatment, Research and Prevention Centre, Toronto Western Hospital and Department of Statistics, University of Toronto, Toronto, Ontario
V.E. Edmonds
Affiliation:
Spinal Cord Injury Treatment, Research and Prevention Centre, Toronto Western Hospital and Department of Statistics, University of Toronto, Toronto, Ontario
L.I. Lapczak
Affiliation:
Spinal Cord Injury Treatment, Research and Prevention Centre, Toronto Western Hospital and Department of Statistics, University of Toronto, Toronto, Ontario
D.F. Andrews
Affiliation:
Spinal Cord Injury Treatment, Research and Prevention Centre, Toronto Western Hospital and Department of Statistics, University of Toronto, Toronto, Ontario
*
Toronto Western Hospital, Suite 4034 Edith Cavell Wing, 399 Bathurst St., Toronto, Ontario, Canada M5T 2S8
Rights & Permissions [Opens in a new window]

Abstract:

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The role of surgery in the management of acute spinal cord or cauda equina injuries remains controversial. The present study analyzed ten admission features and three outcome variables in 208 patients treated in an Acute Spinal Cord Injury Unit, 116 (56%) of whom underwent at least one spinal operation. The surgical and non-surgical groups showed no significant differences in the following seven clinical features: age, sex, distance travelled to the Unit, time interval between trauma and admission, type of accident, severity of injuries to the spinal cord, and severity of associated injuries. However, the two groups showed significant differences in level and type of vertebral column injury, and in the frequency of pre-existing spinal abnormalities. These differences were due to management policies which selected certain injuries for surgical or non-surgical treatment. One-third of the operative procedures were performed primarily for neural decompression, one-third primarily for reduction of bony structures and one-third for fusion. However, 95% of the operative patients had a fusion at the initial operation. Operative treatment was associated with a lower overall mortality rate (6.1%) than non-operative (15.2%), despite a higher frequency of thrombo-embolic complications in the surgical group. Overall, there was no difference between operated and non-operated patients in length of stay or neurological recovery. Surgical management of patients with acute spinal cord injury appears safe in terms of mortality rate and neurological recovery, but it has not been proven to improve the latter.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 14 , Issue S1 , February 1987 , pp. 60 - 69
Copyright
Copyright © Canadian Neurological Sciences Federation 1987

References

REFERENCES

1.Guttmann, L. Spinal cord injuries: Comprehensive management and research. 1973. Blackwell, Oxford.Google Scholar
2.Ducker, TB, Saul, TS. The poly-trauma and spinal cord injury. In: Tator, C.H, ed. Early Management of Acute Spinal Cord Injury. Raven Press, New York 1982; 53–58.Google Scholar
3.Bedbrook, GM. Spinal injuries with tetraplegia and paraplegia. J Bone Joint Surg(B) 1979; 61: 267–84.CrossRefGoogle ScholarPubMed
4.Ahn, JH, Ragnarsson, KT, Gordon, WAet al. Current trends in stabilizing high thoracic and thoracolumbar spinal fractures. Arch Phys Med Rehab 1984; 65: 366–369.Google ScholarPubMed
5.Wilmot, CB, Hall, KM. Evaluation of acute surgical intervention in traumatic paraplegia. Paraplegia 1986; 24: 71–76.Google ScholarPubMed
6.Tator, CH, Duncan, EG, Edmonds, VE, Lapczak, LI, Andrews, DF. Demographic analysis of 552 patients with acute spinal cord injury in Ontario, Canada from 1948 to 1981. In preparation.Google Scholar
7.Tator, CH, Rowed, DW. Current concepts in the immediate management of acute spinal cord injuries. Can Med Assoc J 1979; 121: 1453–1464.Google ScholarPubMed
8.Tator, CH, Rowed, DW, Schwartz, ML. Sunnybrook cord injury scales for assessing neurological injury and neurological recovery. In: Tator, C.H. (ed). Early Management of Acute Spinal Cord Injury. Raven Press, New York 1982: 7–24.Google Scholar
9.Baker, SP, O’Neill, B, Haddon, W, Lomg, WB. The injury severity score: A method for describing patients with multiple injuries and evaluating emergency care. J Trauma 1974; 14: 187–196.CrossRefGoogle ScholarPubMed
10.Greenspan, L, McLellan, BA, Greig, H. Abbreviated injury scale and injury severity score: A scoring chart. J. Trauma 1985: 25: 60–64.CrossRefGoogle ScholarPubMed
11.Rowed, D. Value of somatosensory evoked potentials for prognosis in partial cord injuries. In: Tator, C.H. (ed). Early Management of Acute Spinal Cord Injury. Raven Press, New York 1982: 167–180.Google Scholar
12.Tator, CH, Ekong, CEU, Rowed, DW, Schwartz, ML, Edmonds, VE. Halo devices for the treatment of acute cervical spinal cord injury. In: Tator, C.H. (ed). Early Management of Acute Spinal Cord Injury. Raven Press, New York 1982; 231–256.Google Scholar
13.Edmonds, VE, Tator, CH. Coordination of a halo program for an acute spinal cord injury unit. In: Tator, C.H. (ed). Early Management of Acute Spinal Cord Injury. Raven Press, New York 1982; 263–271.Google Scholar
14.Barkin, M, Herschorn, S, Comisarow, RH. The urologic care of the spinal cord injured patient. In: Tator, C.H. ed. Early Management of Acute Spinal Cord Injury. Raven Press. New York 1982; 273–278.Google Scholar
15.Bharatwal, N. Rehabilitation of cervical cord injuries in the acute phase. In: Tator, C.H. ed. Early Management of Acute Spinal Cord Injury. Raven Press, New York 1982: 291–300.Google Scholar
16.Rowed, DW, Tator, CH. Cervical spondylosis in acute cervical cord injuries. In: Tator, C.H. ed. Early Management of Acute Spinal Cord Injury. Raven Press, New York 1982; 335–347.Google Scholar
17.Schwartz, ML, Tator, CH, Rowed, DW. Atlantoaxial trauma with spinal cord injury. In: Tator, C.H. ed. Early Management of Acute Spinal Cord Injury. Raven Press, New York 1982; 357–364.Google Scholar
18.Tator, CH, Ekong, CEU, Rowed, DWet al. Spinal injuries due to hockey. Can J Neurol Sci 1984; 2: 34–41.CrossRefGoogle Scholar
19.Tator, CH, Rowed, DW, Schwartz, MLet al. Management of acute spinal cord injuries. Can J Surg 1984; 27: 289–294.Google ScholarPubMed
20.Tator, CH, Edmonds, VE. National survey of spinal injuries in hockey players. Can Med Assoc J 1984; 130: 875–880.Google ScholarPubMed
21.Ekong, CEU, Tator, CH. Spinal cord injury in the work force. Can J Surg 1985; 28: 165–167.Google ScholarPubMed
22.Tator, CH, Edmonds, VE. Sports and recreation are a rising cause of spinal cord injury. Phys and Sports Med 1986; 14: 157–167.CrossRefGoogle ScholarPubMed
23.Tator, CH. Spine-spinal cord relationships in spinal cord trauma. Clin Neurosurg 1983; 30: 479–494.CrossRefGoogle ScholarPubMed
24.Tator, CH, Duncan, EG, Edmonds, VE, Lapczak, LI. Andrews, DF. Early morbidity and mortality after acute spinal cord injury. In preparation.Google Scholar
25.Bracken, MB, Collins, WF, Freeman, DFet al. Efficacy of methyl- prednisolone in acute spinal cord injury. J AM A 1984; 251: 45–51.Google Scholar
26.Tator, CH, Duncan, EG, Edmonds, VE, Lapczak, LI, Andrews, DFet al. Factors affecting the cost of early management following acute spinal cord injury. In preparation.Google Scholar
27.Tator, CH, Duncan, EG, Edmonds, VE, Lapczak, LI. Andrews, DF. Utility of an anatomical injury severity score in predicting outcome for patients with acute spinal trauma and associated injuries. In preparation.Google Scholar
28.Morgan, TH, Wharton, GW, Austin, GN. The results of laminec- tomy in patients with incomplete spinal cord injuries. Paraplegia 1971,9: 14–23.Google Scholar