Dura mater decompression to delayed thoracolumbar fractures with spinal cord injury

Objective To evaluate the results of delayed thoracolumbar fractures with spinal cord injury treated by dura mater netlike incisions decompression.Methods Sixty-eight patients of delayed thoracolumbar fractures with spinal cord injury were entered in the study,including 43 males and 25 females with an average of 34.6 years(range,16 to 57).All patients had been treated with laminectomy and internal fixation and left with neurological dysfunction.The Frankel grade showed:grade A 14 cases,B in 36,C in 12,D in 6.The mean time from injury to the index operation was 13 months(range,4 to 26).Due to incompleted decompression or illed internal fixation,these cases need to be re-treated.After removing the scar outside the dura mater,all the patients whose dura mater were observed without throbing within 3-5 minutes,were randomly divided into two groups.In group A,34 cases were undergone only by scar removing from dura mater.In group B,the dura mater of 34 cases were fully revealed,then the thickening and hard parts were selected to be treated by decompression with netlike incisions until the throb of dura mater were resumed.The depth of incisions was only to dural without relating to CSF overflowing.Results All patients were followed up for average 39 months(range 24 months to 10 years).The neurological functional recovery rate was 67.6%(23/34)in group B including Frankel grade improved 2 grade in 12 cases,1 grade 11.For group A,32.4%(11/34)of cases recovered partially(sensory function)including Frankel grade improved 2 grade in 4 cases,1 grade 7.The statistics difference was significant between group A and group B,the same as to pre-operation and post-operation in group B.Partially functional recovery of urinate and cacation was found in 22 cases(64.7%,22/34).Conclusions Dura mater decompression technique is a simple and easy way and has a positive effect to delayed thoracolumbar fractures with spinal cord injury.