DECOMPRESSION AND RECONSTRUCTION FOR SEVERE EXTRADURAL SPINAL CORD COMPRESSION

Study Design: Retrospective outcome measurement study. Objective: To study the functional outcome of surgery for patients presenting with severe extradural spinal cord compression. Subjects: All patients who: 1) were surgically treated for spinal cord compression between January 2001 and December 2003, 2) presented with Frankel grade A, B or C, 3) had extradural spinal cord compression secondary to tumour or infection, and 4) were operated on by a single surgeon. Outcome: Pre- and post-operative functional assessment was made by medical staff, a physiotherapist or both, using the Frankel grading. Frankel grade at 3 months was taken as the end point, unless death had occurred before this time, in which case the best postoperative Frankel’s grade was used. Results: The records of 41 patients with spinal extradural tumour or infection were reviewed. Fourteen patients had Frankel grade A, B, or C. Four were female and 10 male. The median age of the group was 63.5 (range 36 to 73 years). Two had infection and 12 had tumour. The surgical objective was to decompress the neural elements and to restore and maintain the alignment of the vertebral column. One patient had multiple laminotomies alone. Ten had posterior decompression and fusion. Three had anterior and posterior decompression and fusion. Twelve immobile patients became mobile (Frankel grade D and E) and two remained unchanged. Complications were; two superficial wound infection treated with antibiotics, one deep-seated infection requiring open drainage and one extradural haematoma requiring evacuation. Conclusions: Appropriate spinal cord decompression and reconstruction of the spinal column has a very good chance of restoring spinal cord function despite the severity of the presenting neurological deficit.