Late surgery for incomplete traumatic lesions of the conus medullaris and cauda equina.

Abstract

HE role of laminectomy in spinal injury is a subject of great controversy. The various criteria that have been suggested in making the decision for or against surgery include the presence or absence of manometric block, the degree of neurological deficit or preservation of function, and the time between injury and surgery. Opinions regarding the time factor range from pessimism (laminectomy after one year.., had no practical value except when it was done exclusively for psychic reasons 'n ) to enthusiasm 6,9 (laminectomy should be carried out in every case of traumatic paraplegia, early or late2). Many shades of opinion lie between these extremes, a-5,7's,l~ This paper describes our own experience and is intended to lend support to the argument for surgery, even late, in the treatment of lesions in the region of the conus medullaris and cauda equina. This study is based on seven consecutive cases of late laminectomy for traumatic lesions involving the conus medullaris or cauda equina, operated upon at the New York University-Bellevue Medical Center during a 5month period in 1965. Initial Paraplegia. Six of the seven patients had initially been rendered totally paraplegic, the seventh partially. However, all had experienced partial subsequent improvement. Interval. The interval between injury and surgery ranged from 1 month to 17 years. Four of the seven patients were operated on 2�89 years or longer after injury, while three were operated on 1, 2, and 9 months after injury.