EFFECT OF SURGERY ON MOTOR RECOVERY FOLLOWING TRAUMATIC SPINAL-CORD INJURY

The influence of spine surgery on motor recovery between 1 month and 1 year was assessed prospectively in a group of 269 patients following traumatic spinal cord injury (SCI) using the classification system ori ginally developed by the American Spinal Injury Association. The Alien classification was used to categorize cervical vertebral pathology an d the Denis system was used for injuries to the thoracic and lumbar sp ine. Gunshot injuries were classified based upon the bullet trajectory and location relative to the spinal canal. Individuals undergoing sur gery were divided into various subgroups depending on the type of surg ery performed: anterior decompression with or without spine fusion and instrumentation, posterior decompression/laminectomy with or without spine fusion and instrumentation and spine fusion with instrumentation . Motor score recovery between 1 month and 1 year after injury was hig hly dependent (P less than or equal to 0.001) on the level and complet eness of injury averaging 0.7+/-2.7 for complete paraplegics, 7.8+/-4. 8 for complete tetraplegics, 11.8+/-8.3, for incomplete paraplegics an d 22.2+/-10.9 for incomplete tetraplegics. Motor recovery did not sign ificantly differ between patients categorized in various surgical subg roups or between those having surgery and those treated non-operativel y. Additionally, although the sample size was small, motor recovery am ong tetraplegic individuals did not depend on whether unilateral and b ilateral facet dislocations were reduced and in patients with incomple te lesions, those with reductions actually had a poorer outcome than t hose who were left in a dislocated position.