[Severe cervical spinal cord injuries without traumatic osteo-disco-ligamentous lesion]

The existence of cervical spinal cord injury without bony nor disco-ligamentous lesion rises pathogenic, prognostic and therapeutic challenges. The extent and localisation of cord injury, which depends on intensity and direction of the applied force, can explain the different clinical patterns: incomplete quadriplegia: 8 cases, incomplete Brown-Sequard-like quadriplegia: 2 cases, diplegia brachialis: 5 cases. We have not observed any complete quadriplegia. The presence of arthritic or congenital spinal canal stenosis has been found in 12 cases. We have used a coupled myelographic-CT Scan study. MRI has been employed more recently. This X-ray study has never found any major cord compression. Improvement of neurologic troubles, under medical treatment, was constant, but sequelae were always present, hands being most concerned; their importance was paralleled to the initial clinical feature. The Brown-Sequard-like quadriplegia were more pejorative. 3 patients, after an initial improvement, have presented a cervical myelopathic evolution and have been successfully operated on. On the other hand, the only initially operated on patient has been immediately worsened. Operation is indicated by the third week, when coexist: a spinal stenosis and a poor clinical evolution.