Acta Ortopédica Mexicana

Martínez-Padilla LA, Dufoo-Olvera M, García-López OF, López-Palacios JJ, Carranco-Toledo GA, Aburto-Trejo JA
Neurologic changes in patients with traumatic cord lesion based in the analysis of the sequential clinical history
Acta Ortop Mex 2008; 22 (6)

Language: Español
References: 20
Page: 374-383
PDF: 451.54 Kb.

[Fulltext - PDF]

ABSTRACT

Objective: To determine changes in neurological status in patients with traumatic cord lesions before and after surgical treatment. Material and methods: We conducted a descriptive cohort study, and measured 61 points of neurologic evaluation (sensory, motor, reflexes) of the Sequential Clinical History. Results: We studied 28 patients with complete cord lesion (ASIA A) and 16 with incomplete cord lesions (9 ASIA B, 4 ASIA C, and 3 ASIA D). In the patients classified as ASIA-A, twenty-six did not change, and 2 had improvement in one neurologic level (sensory). In ASIA-B patients, four remained with no changes, and in 5 the lesion improved. The four patients with type C lesion, improved. All patients with ASIA-D, improved to ASIA-E. Conclusion: In patients with complete cord lesions (ASIA-A) and the worst prognosis, we did not find improvement in neurologic lesion. In incomplete cord injuries, improvement was variable, and it was more prevalent in preoperative period.


Key words: neurologic exam, spinal cord lesions.


REFERENCES

  1. Oleson CV, Burns AS, Ditunno JF, et al: Prognostic value of pinprick preservation in motor complete, sensory incomplete spinal cord injury. Arch Phys Med Rehabil 2005; 86: 988-92.

  2. Dufoo OM, García LO, López PJ, et al: Historia Clínica Secuencial para la evaluación de pacientes con lesión raquimedular. Descripción, análisis y experiencia de 14 años. Rev Mex Ortop Traum 1998;12(6): 483-90.

  3. American Spinal Injury Association: Standard neurological classification of spinal cord injury: 2006_Classification worksheet. Am Spin Inj Assoc. Chicago. 2006.

  4. Fehlings MG, Perrin RG: The role and timing of early decompression for cervical spinal cord injury: update with a review of recent clinical evidence. Injury 2005; 36: S-B13-26.

  5. Stevens RD, Bhardwaj A, Kirsch JR, Mirski MA: Critical care and perioperative management in traumatic spinal cord injury. J Neurosurg Anesth 2003; 15(3): 215-29.

  6. Bracken MB, Shepard MJ, Collins WF, et al: A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 1990; 322(20): 1405-11.

  7. Bracken MB, Holford TR: Effects of timing of methylprednisolone or naloxone administration on recovery of segmental and long-tract neurological function in NASCIS 2. J Neurosurg 1993; 79(4): 500-7.

  8. Bracken MB, Shepard MJ, Holford TR, et al: Administration of methylprednisolone for 24 or 48 hours or tirilazad mesylate for 48 hours in the treatment of acute spinal cord injury. Results of the Third National Acute Spinal Cord Injury Randomized Controlled Trial. National Acute Spinal Cord Injury Study. JAMA 1997; 277(20): 1597-604.

  9. The Section of Disorders of the Spine and peripheral nerves of the American Association of Neurological Surgeons and the Congress of Neurological Surgeons: Guidelines for management of acute cervical spine injuries. Chapter 9. Pharmacological therapy after acute cervical spinal cord injury. Neurosurgery 2002; 50: S63-72.

  10. Bernhard M, Gries A, Kremer P, Böttiger BW: Spinal Cord Injury (SCI)-Prehospital management. Ressucutation 2005; 66: 127-39.

  11. Bledsoe BE, Wesley AK, Salomone JP, for the National Association of EMS Physicians and Clinical Practice Committee: High-dose steroids for acute spinal cord injury in emergency medical services. Prehosp Emerg Care 2004; 8: 313-6.

  12. CRASH Trial Collaborators. Effect of intravenous corticosteroids on death within 14 days in 10008 adults with clinically significant head injury (MRC CRASH Trial): randomized placebo-controlled trial. Lancet 2004; 364: 1321-8.

  13. Oleson CV, Burns AS, Ditunno JF, et al: Prognostic value of pinprick preservation in motor complete, sensory incomplete spinal cord injury. Arch Phys Med Rehabil 2005; 86: 988-92.

  14. Marino RJ, Ditunno JF Jr, Donovan WH, Maynard F Jr: Neurologic recovery after spinal cord injury: data from the Model Spinal Cord Injury Systems. Arch Phys Med Rehabil 1999; 80: 1391-6.

  15. Go DK, DeVivo MJ, Richards JS: The epidemiology of spinal cord injury. In: Stover SL, DeLisa JA, Whiteneck GG, editors. Spinal cord injury: clinical outcomes from the model systems. Gaithesburg; Aspen; 1995: 21-51

  16. Fattal C, Leblond C: Évaluation des aptitudes fonctionnelles, du handicap et de la qualité de vie chez le blessé médullaire. Ann Readapt Méd Phys 2005: 48: 346-60.

  17. Scivoletto G, Morganti B, Molinari M: Early versus delayed inpatient spinal cord injury rehabilitation: an Italian study. Arch Phys Med Rehabil 2005; 86: 512-6.

  18. Crozier KS, Graziani V, Ditunno JF Jr, Herbison GJ: Spinal cord injury: prognosis for ambulation based on sensory examination in patients who are initially motor complete. Arch Phys Med Rehabil 1991; 72: 119-21.

  19. Waters RL, Adkins RH, Yakura JS, Sie I: Motor and sensory recovery following incomplete tetraplejia. Arch Phys Med Rehabil 1994; 75: 306-11.

  20. Geisler FH, Coleman WP, Grieco G, Poonian D: Sygen Study Group. Measurements and recovery patterns in a multicenter study of acute spinal cord injury. Spine 2001; 26(24 Suppl): S68-86.