Abstract
Paraplegia is a well-defined state of complete motor deficit in lower limbs, regardless of sensory involvement. The cause of paraplegia usually guides treatment, however, some controversies remain about the time and benefits for spinal cord decompression in nontraumatic paraplegic patients, especially after 48 hours of the onset of paraplegia. The objective of this study was to evaluate the benefits of spinal cord decompression in such patients. We describe three patients with paraplegia secondary to non-traumatic spinal cord compression without sensory deficits, and who were surgically treated after more than 48 hours of the onset of symptoms. All patients, even those with paraplegia during more than 48 hours, had benefits from spinal cord decompression like recovery of gait ability. The duration of paraplegia, which influences prognosis, is not a contra-indication for surgery. The preservation of sensitivity in this group of patients should be considered as a positive prognostic factor when surgery is taken into account.
Highlights
Paraplegia is a well-defined state of complete motor deficit in lower limbs, regardless of sensory involvement, with muscular strength grading zero
Some controversies remain about the timing for spinal cord decompression in patients with muscular strength grading zero, especially when the sensory modality is damaged[1]
This report discusses an atypical evolution of three patients submitted to spinal cord decompression after more than 48 hours of onset of paraplegia
Summary
Paraplegia is a well-defined state of complete motor deficit in lower limbs, regardless of sensory involvement, with muscular strength grading zero. Case 1 A 33-year-old man, complaining of dorsal thoracic pain for 2 months, was admitted to the emergency unit with paraplegia for 4 days and urinary retention with partially preserved tactile and painful sensitivity in lower limbs. A magnetic resonance (MR) of the thoracic spinal segment was compatible with an extradural lesion located in the dorsal portion of the cord at T8 level (Figure 1) He underwent a laminectomy T6 to T9 on the fourth day after the total paraplegia had begun. Two months after the surgery the patient presented a sudden paraplegia and lost sphincter control Her pain and tactile sensitivity in both legs were maintained. He discontinued the use of urinary catheter and regained sexual activity
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