Outcome of Late Anterior Surgery and Arthrodesis of Lower Cervical Spinal Cord Injury

Abstract

Objective: To evaluate the efficacy and outcome of late anterior surgery and arthrodesis of lower cervical spinal cord injury. Study design: Prospective Analysis. Setting: Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka; Bangladesh. Subjects and Methods: 32 consecutive patients with sub axial cervical spinal cord injury managed surgically from January 2000 to July 2005 by late anterior surgery and autologous bone graft stabilization considered as study unit. The indications of surgery were persistent cervical spinal cord compression and / or instability of cervical spine. Most cases were admitted late and operations were carried out as late 1 week to 27 weeks after injury. All the patients were investigated by radiograph and MRI of cervical spine accordingly. Post operative patient were followed up for twice, just before discharge from hospital and there-after minimum 3 months to 3 years. Quantification of deficit and neurological outcome were rated by American Spinal Injury Association (ASIA) classification system. Results: Males were found predominant with 93.75% over the female 6.25%; with ratio is 15: 1. Minimum age of the patient is 16 years and maximum age is 55 years. Most frequently (37.50%) encountered group were between the age of 31 to 40 years. Mean age is 32.29±10.09 years. Falling due to slip while carrying heavy load on head and / or neck (37.50%) was the most common cause of sub axial cervical spinal injury followed by road traffic accidents (31.25%), which may not be reported elsewhere till to-date. 31.25% suffered a single vertebral level, 62.50% patients suffered two vertebral levels and 6.25% patients suffered three level vertebral levels. The commonest skeletal level was C5/6 (46.87%) followed by C5 (25.00%) but C5 (46.87%) was commonest neurological level followed by C4 (18.75%). 81.25% of patients sustained a neurological injury. Of these, 75.00% had incomplete neurological deficit. After the operative procedure these incomplete neurological deficit patients have shown very attractive neurological recoveries. 6.25% of total population, who had complete neurological deficit, was graded as ASIA grade - A did not show any neurological recovery. In the current series none of the patients had worsening of neurological deficit due surgical intervention. Conclusion: This study offer significant potential for repairing some of the damage caused by cervical spinal cord injury. Further more, though controversy exists as to the ideal approach and timing (early versus late surgery) we have seen that benefits derived from late anterior surgery in our patients. Key words: Spinal Cord Injury; ASIA impairment scale; Neurological outcome. DOI: 10.3329/jdmc.v18i1.6306 J Dhaka Med Coll. 2009; 18(1) : 47-53