Functional evaluation of treatment outcome in fractures of the cervical spine

Introduction. Fractures of the cervical spine are becoming more and more frequent, which is causing the number of disabled persons to increase. Proper handling of the patient on the scene of the accident, proper transport to the hospital, and the correct interpretation of indications for surgical intervention can contribute to reducing the number of complications and improving treatment outcome.
Material and method. Our research involved 132 patients, 86 men and 46 women, operated as a result of traumatic injury to the spine and spinal cord with neurological deficits of varying degree. The patients were evaluated neurologically before surgery and divided into three groups on the deficits discovered. Their functional status was tested by means of the Functional Independence Measure (FIM) before surgery (Exam I), one week after surgery (Exam II), and approximately 6 months after surgery (Exam III).
Results. Improvement occurred in our patients in all the measured parameters, depending on the preoperative status of the patient. The greatest improvement in respect to functional independence was gained by those patients who prior to surgery presented with the largest neurological deficits; however, due to the very low preoperative level of functioning exhibited by these patients their condition, even after considerable improvement, was less than fully satisfactory. Somewhat less improvement took place in the patients with a moderate level of neurological deficit, while the least improvement occurred in the patients who presented with minimal neurological deficits. The condition of the patients in this last group was close to normal.
Conclusions. The proposed surgical method in many cases facilitated a rapid return to health; within only a few days after surgery these patients obtain more complete sphincter control, greater motor capability, more self-sufficiency, and better social functioning. The treatment outcomes are dependent on the patient's preoperative status.