Late Anterior Decompression for Treatment of Spinal Cord Injury: A Preliminary Result

Objective To study the indications and time limit of late anterior decompression for spinal cord injury (SCI). Methods Between January and December 2002, 56 patients with late SCI secondary to fracture or dislocation of the spine were admitted for treatment. The interval between the sustained injury and the operation performed varied from 0.5 to 31 years (mean 3.6 years). The location of spinal fracture was between C 4 and T 1 in 19 patients, T 2-T 9 in 9, and T 11 -L 2 in 28. Complete paralysis was present in 46 patients and incomplete injury in 10. Radiographic examinations revealed that there were demonstrable bone and disc fragments compressing the anterior spinal cord and/or kyphotic deformities in all patients. Anterior decompression was carried out followed by internal fixation if necessary. Results Postoperative imaging examinations revealed that displaced fragments of bone or disc compressing the anterior aspect of the spinal cord were resected totally in each patient. The short-term follow-up varied from 20 days to 6 months with an average 30 days. Of the 56 patients, 53 achieved substantial neurological improvement at different degree including improvement of the limb spasticity, recovery of the sweat, relief of the radicular pain, descend of the sensory level, improvement of motor function, anal sensation recovery and better sphincter control and bladder function. There is no worse case after surgery. The total effective rate is 94.6%. Conclusion ①Late anterior decompression and fusion benefits the neurologic recoveries of patients with SCI including incomplete and complete cord syndromes. The results indicate that the patients who were operated in 1～2 years after injury not necessarily get much better results than those operated upon 5～10 years after injury. Further research into the relation between the long-term outcome of operation and the operative time will be required. ② The indications for late anterior decompression are all patients who sustain a mass compressing of the anterior spinal cord and/or severe kyphosis proven by the radiographic examination. Complete decompression should always be attempted. ③ The stability of spine should be considered in old SCI cases during anterior decompression. The selection of some stabilization procedure should be conducted based on the associated osseous and ligamentous traumatic pathology.