Session IX - Spine
Results of Spinal Cord Decompression and Thoracolumbar Pedicle Stabilization in Relation to the Time of Operation
Christian Gaebler, MD1; Friedrich Kutscha-Lissberg, MD2; Richard Maier, MD3; Vilmos Vécsei, MD1; Manfred Greitbauer, MD; 1University of Vienna Medical School, Department of Traumatology, Vienna, Austria; 2Bergamnnsheil Trauma Hospital, Bochum Germany; 3General Hopital Baden, Baden, Austria
Purpose: We investigated whether early operation was of any advantage in the treatment of patients with thoracolumbar spine fractures.
Methods: A follow-up examination of 88 patients who underwent posterior short-segment pedicle stabilization between 1985 and 1992 took place after an average time of 5.6 years. The patients were subdivided into three groups according to the timing of the operation: group I, operation within 8 hours after the accident; group II, operation after 8 hours, but within 10 days; and group III, operation more than 10 days after the accident. Twenty-six patients (29.6%) were operated on within 8 hours after the accident (group I), 50 patients (56.8%) were operated on after 8 hours (group II), and 12 patients (13.6%) were operated on after a delay of 10 days or more (group III).
Results: The outcome of these patients regarding neurologic recovery rates demonstrated three facts. First, patients of group I demonstrated a rate of neurological recovery significantly higher (P < 0.001) than that of the patients of groups II and III. One patient of group I even showed a remission of complete paraplegia up to a neurologic situation of Frankel grade D. Second, patients with incomplete neurologic deficits of Frankel grade B to D, who showed a complete remission of their neurologic deficits to Frankel grade E (N = 21), had been operated on within an average time of 36 hours (P < 0.0001). Third, all patients with incomplete paraplegia, who were operated on within 48 hours (P < 0.001) showed a remission of at least one Frankel grade. In patients operated on later, there was no significant difference in neurologic recovery rates. The rate of complications in the 88 patients with posterior stabilization was 11.4%. There were two cases (2.2%) of nonunion. Eight revision operations were performed; two because of a nonunion, three because of a deep wound infection, and three because the primary aim of the operation had not been achieved. In these cases remaining posterior wall fragments had to be reduced in a revision operation after the postoperative CT scan.
Discussion: Our results suggest that the earlier operative decompression and spine stabilization takes place, the better is the recovery rate among patients with neurologic deficits. The highest neurologic recovery rates were found among patients operated on within 8 hours after the initial trauma. Our results suggest the importance of an early decompression of the spinal cord. A complete remission of neurologic deficits (Frankel B to D) was seen only among patients decompressed and stabilized within 36 hours. High remission rates were found if the patients had been operated on within 48 hours. After this time there was no significant difference in the neurologic outcome compared with the time of operation.
Conclusion: Patients with thoracolumbar fractures and neurological deficits should be operated on within 8 hours after trauma.