Early treatment of cervical spinal cord injuries based on post mortem pathological studies
Kinoshita, H.
No Shinkei Geka. Neurological Surgery 8(2): 155-166
1980
ISSN/ISBN: 0301-2603 PMID: 7360317 Document Number: 165960
Early treatment procedures, especially surgery, in cervical spinal cord injuries were reviewed based on post mortem findings of 23 cases. The excised cervical column was examined by X-ray in rotation, flexion and extension, and the films were compared with those taken at the time of initial examination. The true state of dislocation sustained at the time of injury occasionally is not recognized due to spontaneous reduction while the patient is being transported. Injury caused by hyperextension in an aged person with an arthritic spine is accompanied by edema involving many segments and decompression by surgical intervention is difficult. In many instances, incomplete paralysis is noted clinically and the treatment should consist of immobilizing the cervical spine to prevent it from assuming a position of extension. In cases with cervical spine injury caused by disc damage, the conservative procedure of skull traction is an adequate measure, but as autopsy findings show the spinal cord lesion to be localized within a small area, improvement of paralysis can be expected by removal of the extruded disc. In cases with cervical injury caused by fracture or fracture-dislocation, there is serious gross contusion and transection of the cord. Of 10 cases examined, 9 had complete paralysis as a result of the extensive damage. In these cases surgery was not recommended. Among the autopsy cases with incomplete paralysis, there were some in whom there was cavitation of the gray matter while the white matter in the area was well preserved. As the gray matter is easily destroyed and tends to be hemorrhagic, if appropriate treatment is administered within 4-6 h or before damage extends to the white matter, it should be possible to prevent the white matter from undergoing irreversible neural changes, which is of greatest importance.