COMPARATIVE-STUDY OF FUNCTIONAL RECOVERY FOR SURGICALLY EXPLORED AND CONSERVATIVELY MANAGED SPINAL-CORD MISSILE INJURIES

OBJECTIVE: In a retrospective study, the extent of functional recovery and the merits of surgical exploration versus conservative management for spinal cord injuries were evaluated for 145 casualties from the f ront lines of the Iran-Iraq conflict. METHODS: Eighty-seven patients w ho underwent surgical exploration and 58 patients who were conservativ ely treated were monitored for 6 to 140 months (average, 57 +/- 31 mo) for any changes from their baseline neurological status, using the Fr ankel Scoring System. RESULTS: Twenty-two of 90 patients (24.4%) with complete injuries (Frankel score A) and 53 of 55 (96.4%) with incomple te injuries (Frankel scores B, C, and D) experienced changes in their neurological status as they recovered. Improvement was noted for 42 of 87 surgically treated patients (13 of 55 with complete injuries and 2 9 of 32 with incomplete injuries). Among conservatively treated patien ts, improvement was noted for 32 of 58 (55%), including 25.7% of those with complete injuries and 100% of those with incomplete injuries. In dependent walking (Frankel scores D and E) was achieved by 10 of 90 pa tients with complete injuries and by 52 of 55 patients with incomplete injuries. Surgery did not affect the final outcome. Thirteen of 17 (7 6%) cerebrospinal fluid fistulas, 13 of 15 (87%) meningitides, and 4 o f 6 (67%) local septic complications were encountered in the surgicall y treated group. CONCLUSION: Surgery did not enhance functional recove ry from spinal cord missile injuries but did correlate with an increas ed prevalence of complications (fistulas, meningitis, and local sepsis ). With or without surgical exploration, patients with seemingly compl ete cauda equina injuries demonstrated better functional outcome than did those with spinal cord injuries.