EARLY SURGERY FOR THORACOLUMBAR SPINAL-CORD INJURY - INITIAL EXPERIENCE FROM A DEVELOPING SPINAL-CORD INJURY CENTER IN INDIA

The spinal cord injury centre of Nizam's Institute of Medical Sciences , Andhra Pradesh, India has been functioning now for 8 months and offe rs its services to the population of 80 million in the state. To date, 92 patients with a spinal cord injury have been treated; 51 had a tho racolumbar spinal injury. This report presents the results of the mana gement of these 51 patients. Preoperatively both CT and MRI were perfo rmed and the radiological findings were correlated with outcome. Twent y five had a thoracic and 26 a lumber location. Twenty nine patients u nderwent surgical treatment (15 thoracic and 14 lumbar) and the others were treated conservatively (10 thoracic and 12 lumbar). Ah these ope rations were carried out within 2 weeks following trauma, and methylpr ednisolone therapy was instituted in those who reached the hospital ea rly. Contraindications for surgery included a delay in admission of mo re than 3 weeks following trauma, a focus of sepsis, bedsores, a gener alised bone disorder such as osteopenia, and medical illnesses. Transp edicular screw-plate fixation was performed in 27 patients, and two pa tients underwent decompressive laminectomy and interlaminar bone and w ire fixation. Delayed spinal decompression was offered to one patient to relieve radiculopathy. Fracture-dislocation spinal injury and those with transection of the spinal cord had the worst outcome, whilst pat ients with a wedge compression fracture and cord oedema fared better. Operated cases had a shorter hospital stay, and complications of immob ilisation were limited. Positive psychological influence of mobilisati on and early acclimatisation to the altered style of Living with their disability were the most significant outcomes following surgery.