Anterior decompression of the spinal cord for neurological deficit

With newer radiographic methods for defining abnormalities affecting the spine, and improved surgical techniques, anterior decompression has proved effective in improving neurologic return when pressure on the cord is directed from anteriorly. Twenty-five patients undergoing anterior decompression for partial neurologic deficit fit into one of four categories: 1) fracture, 2) tumor, 3) infection, and 4) congenital scoliosis. Operative procedures were performed over a period of 15 years with the longest follow-up being 15 years. Of the 25 patients, 19 have been followed for greater than two years. No patient in this series showed worsening of his neurologic status on a permanent basis. The most dramatic improvement was noted in the fracture cases, although in cases of infection and tumor were almost as exciting. In the congenital cases recovery was slow and in some cases not as dramatic; however, progression of neurologic deficit in all cases was halted. In those cases showing a progressive deficit the deterioration was halted. With our present surgical skills and our increased armamentarium of diagnostic techniques and conservative treatment, hopeful waiting for return of neurologic function should no longer be tolerated where the lesion is exerting anterior pressure on the spinal cord.