The effects of surgical intervention on nerve functional recovery following hyperextension injury to the cervical spinal cord with preoperative dropsy and postoperative central necrosis

Abstract

Objective To determine the effect of surgical intervention on nerve functional recovery following hyperextension injury to the cervical spinal cord with preoperative dropsy and postoperative central necrosis. Methods A total of 36 cases of hyperextension injury to the cervical spinal cord with preoperative dropsy and postoperative central necrosis were surgically treated in our department from January 2006 to August 2010. Patients were categorized respectively into a group of operation within 24 hours and a group of operation beyond 24 hours, and an anterior approach group, a posterior approach group and an anterior-posterior approach group as well.Preoperative and postoperative MRI examinations were conducted to observe the time and location of formation of any central necrosis at the spinal cord.American Spinal Injury Association motor score (AMS) and recovery rate (RR) were compared between preoperation and postoperation in all groups. Results The 36 patients were followed up for 12 to 52 months (average,28 months).Formation of spinal cord central necrosis was found on MRI in all cases one month postoperation and the necroses were still observed 6 munths postoperation and at the last follow-up. Compared with the baseline,the AMSs 6 months postoperation and at the final follow-up in each group were significantly higher ( P ＜ 0.05).There was also a significant difference between 6 months postoperation and the final follow-up regarding AMS in all groups(P ＜ 0.05).Comparison of postoperative RRs showed that the group of operation within 24 hours was significantly betterthan the group of operation beyond 24 hours (P ＜0.05),the groups of anterior approachand anterior-posteriorapproachweresignificantly beuer than thegroupofposteriorapproach (p ＜0.05). Conclusions Early operation and full decompression may increase the motor RR in patients with hyperextension injury to the cervical spinal cord plus preoperative dropsy and postoperative central neerosis.The nerve functional recovery tends to slow down in patients with spinal cord central necrosis 6 months after operation. Key words: Spinal cord injuries; Cervical vertebrae; Surgical procedures, operative; Treatment outcome