Functional outcome after incomplete spinal cord injuries due to blunt injury

During a 3-year period, 19 patients with incomplete spinal cord injuries caused by blunt trauma were admitted to a single rural referral centre. The mean age was 50 years. Injury mechanisms included falls in eight, road traffic accidents in five, diving mishaps in two, and miscellaneous in four. The level of spinal cord injury was cervical in 11, thoracic in five, and thoracolumbar in three. Initial management included a standard high-dose methylprednisolone protocol for 24 h after injury in eight patients treated since May, 1990. Neurosurgical procedures were performed in 11 patients. There were three deaths, all in patients over 75 years of age with pulmonary complications. Of 16 survivors, 10 demonstrated significant functional neurological improvement by the time of hospital discharge, and 11 by late follow up. Complete recovery occurred in five of the survivors. Complications occurred in 11 patients, including pulmonary (nine), infectious (six), and gastrointestinal (three), but could not be associated specifically with the high-dose steroid protocol. In conclusion, incomplete spinal cord injuries after blunt injury were relatively uncommon in this setting. No significant increase in complications was observed after institution of the high-dose methylprednisolone protocol in May, 1990. However, pulmonary, gastrointestinal, and infectious complications were common. Of the 16 survivors, 11 demonstrated significant functional improvement. Mortality appeared to be related to advanced age and to pulmonary complications.