THE ROLE OF DECOMPRESSION FOR ACUTE INCOMPLETE CERVICAL SPINAL-CORD INJURY IN CERVICAL SPONDYLOSIS

Study Design. A prospective study was conducted in 37 patients with ce rvical spondylosis with incomplete cord injury to assess the role of d ecompression in these patients. Objective. To evaluate surgical and no nsurgical outcomes in patients with pre-existing cervical spondylosis of the spine, in whom an incomplete spinal cord syndrome developed aft er a minor neck injury. Summary of Background Data. The benefits of su rgical treatment of incomplete cord injury with cervical spondylosis i s controversial but remains a treatment option. The results of this st udy clarified the benefits of surgery in such patients. Methods. Radio graphic findings and outcomes based on post-spinal injury motor functi on score were compared retrospectively in 37 patients with cervical sp ondylosis. Sixteen patients were treated operatively and 21 were treat ed nonoperatively. Results. The neurologic conditions of 13 of the 16 patients (81.2%) treated surgically improved within 2 days of surgery. Comparing the improvement of the two groups at defined intervals, the re were statistically significant differences (P < 0.006) between the surgical and nonsurgical patients at 1-month and 6-month follow-ups. N evertheless, 13 of the 21 patients (62%) treated nonoperatively had re covered to at least muscle Grade 3 at the 2-year follow-up, but their recovery was slower than that of the surgical group. Conclusion. Altho ugh neurologic improvement after an incomplete spinal cord injury when no bony lesion was present was slow during the first few months after trauma, more than 60% of the patients showed neurologic recovery with a muscle grade higher than 3 at 2-year follow-up. Surgical decompress ion, however, was associated with immediate neurologic improvement, fa ster recovery of neurologic function, early mobilization, better long- term neurologic outcome, briefer hospital stays, and fewer complicatio ns related to long confinements in bed than was nonoperative treatment .