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Injury pattern effect on motor recovery after traumatic spinal cord injury
R L Waters1, I Sie, R H Adkins
1Regional Spinal Cord Injury Care System of Southern California, Rancho Los Amigos Medical Center, Downey 90242, USA.
Objective:
To determine whether type of fracture or gunshot injury correlated with extent of motor impairment at 1 month and/or with the amount of motor recovery between 1 month and 1 year.
Design:
Prospective neurological examinations were performed longitudinally after the recommendations of the American Spinal Injury Association (ASIA). Fractures were classified by the Allen system (cervical spine) or the Denis system (thoracic and lumbar spine). Gunshot injuries were classified based on trajectory and bullet location.
Setting:
Subjects were examined at a community medical center.
Patients:
There were 278 patients with traumatic spinal cord injury who were admitted between 1985 and 1990.
Main Outcome Measures:
The ASIA motor score was the primary outcome measure.
Results:
There were no significant differences in motor recovery based on type of injury (penetrating vs nonpenetrating), type of fracture, or bullet location.
Conclusions:
Injuries severely disruptive of the spinal canal were more likely to result in complete SCI. Flexion-rotation injuries in the thoracic and lumbar spine, bilateral facet dislocations in the cervical spine, and gunshot wounds in which the bullet passed through the canal were more likely to be complete. Incomplete injuries were more common among patients with preexisting cervical spondylosis who had fallen and patients with gunshot wounds in which the bullet did not penetrate the spinal canal. The primary determinant of motor recovery was completeness of injury at 1 month.