Early stabilization and decompression for incomplete paraplegia due to a thoracic-level spinal cord injury

All patients treated between 1985 and 1990 for acute incomplete spinal cord injury between T2 and T11 were retrospectively studied. This level was chosen for study because by excluding cervical cord, conus, and cauda equina injuries, neurologic improvement could be attributed to improvement of spinal cord function. Only 14 patients with incomplete thoracic level paraplegia were identified, representing 1.2% of all spinal injuries. All 14 patients were treated by early operative reduction, stabilization, or decompression. Twelve patients had surgery within 24 hours of neurologic injury, one at 36 hours, and one at 5 days. Twelve patients had initial posterior instrumentation and fusion, one of whom subsequently had an anterior decompression. Two patients had initial anterior decompression and fusion. Both later had posterior instrumentation and fusion to treat progressive deformity. Follow-up averaged 20 months (range, 9-65 months). Neural function before surgery and at follow-up was given a Frankel grade and lower extremity motor index score. Of 13 surviving patients, seven were initially Frankel B and six Frankel C. Of the seven patients initially Frankel B, four recovered to Frankel E, two improved to Frankel D, and one remained Frankel B. Of the six patients originally Frankel C, five recovered to Frankel E and one improved to Frankel D. Average neurologic improvement was 2.2 Frankel grades per patient, lower extremity motor index improved from an average of 7 to 44. Early surgical reduction, stabilization, and decompression is safe and improves neurologic recovery in comparison to historical controls treated by postural reduction or late surgical intervention.