The effect of timing of surgical intervention on functional recovery of the hand and treatment of hyperextension injury to the cervical spinal cord

Abstract

Objective To determine the correlations between the time of surgical intervention, effect of surgery and functional recovery of the hand in the treatment of hyperextension injury to the cervical spinal cord. Methods We treated 34 cases of cervical hyperextension injury from February 2005 to August 2009. According to the time of surgical intervention, they were classified into 3 groups. In group A, 17 cases received operation within 6 days, in group B 10 cases had operation from 6 to 14 days, and in group C, 7 cases had operation after 14 days. The 3 groups were compared respectively in terms of their preoperative and postoperative American Spinal Injury Association (ASIA) motor scores and their functional recovery of the hands' intrinsic muscle. Results They were followed up for 12 to 40 months. By ASIA scores for spinal nerve function, group A was significantly better than groups B ( P =0. 025) and C ( P =0. 042) in one month and at the last follow-up after operation but there was no significant difference between group B and C ( P =0. 849) . In strength of the intrinsic muscle in one month after operation, there was no significant difference (P = 0. 101 ) between the 3 groups. In the neural function at the last follow-up, group A was significantly better than group B ( P = 0. 034) and group C ( P = 0. 006), but there was no significant difference ( P =0. 217) between groups B and C, Conclusions Patients with hyperextension injury to the cervical spinal cord should be operated on within 6 days after injury. Early operative decompression is the key to nerve functional recovery and reduction of associated complications. The short-term functional recovery of the hand intrinsic muscle may have no obvious relation to the time of surgical intervention but the long-term recovery may be obviously related to the operative time. Key words: Cervical vertebrae; Spinal cord injuries; Treatment outcome