[Preclinical diagnosis of traumatic paraplegia or tetraplegia -- a prospective study in 100 patients]

To avoid neurological deterioration, traumatic spinal cord injury has to be recognized as early as possible. Aim of the study was to analyze alterations of the neurological level of injury in the preclinical interval.

In a prospective observational study the clinical diagnoses of 100 patients referred to the Swiss Paraplegic Centre in Nottwil, Switzerland, were compared to the preclinical diagnoses.

In 12 patients we observed neurological deterioration for more than 2 spinal segments. Six of these patients had been diagnosed preclinically with paraplegia at a neurological level of T4 or T5, whereas the evaluation in the hospital showed cervical spinal cord injury and tetraplegia.

Possible reasons for this neurological deterioration can be secondary damages of the nervous tissue due to vascular, metabolic or biochemical mechanisms, transportation trauma or insufficient preclinical diagnostics. There is no evidence for a higher risk of secondary tissue damage for patients with cervical spinal cord injury. None of the six patients had additional injuries of the spinal cord or the vertebral column in the thoracic region, therefore transportation trauma is also unlikely. It is more likely that preclinical diagnoses were incorrect, what could have been avoided by consequent sensory and motor testing at the upper extremities.