Download PDF
Indian Journal of Neurotrauma 2004; 01(01): 9-16
DOI: 10.1016/S0973-0508(04)80020-0
Review Article
Thieme Medical and Scientific Publishers Private Ltd.

Evaluation of Surgical Intervention in Acute Spinal Cord Injured Patients – A review

PS Ramani
Subject Editor:
Further Information

Publication History

Publication Date:
05 April 2017 (online)

  PDF Download  Permissions and Reprints

Abstract

Spinal Cord Injury is a devastating form of Neurotrauma known to mankind since antiquity. It strikes mostly the young, and leads to lifelong disability. The pathology, besides the mechanical disruption of neural tissue, involves complex biological events which are gradually unfolding and being recognised clinically and in the laboratory. Surgical stabilisation is important for early rehabilitation. The role of methyleprednisolone in acute spinal cord injury is still not convincing.

Keywords

methyleprednisolone - spinal cord injury
 

  • References

  • 1 Fehlings MG, Sekhon L. Cellular: Ionic and biomolecular mechanisms of the injury process. In: Benzel E, Tator CH. (eds). Contemporary Management of Spinal Cord Injury: From Impact to Rehabilitation. 33 2000. AANS; Chicago. IL: 112-116
    Google Scholar
  • 2 Krengel WF, Anderson PA, Henley MB. Early stabilization and decompression for incomplete paraplegia due to a thoracic-level spinal cord injury. Spine 18 1993; 2080-2087
    CrossrefPubMedGoogle Scholar
  • 3 Tator CH, Fehlings MG. Review of the secondary injury theory of acute spinal cord trayma with emphasis on vascular mechanisms. J Neurosurg 75 1991; 15-26
    CrossrefPubMedGoogle Scholar
  • 4 Bracken MB, Holford TR. Effects of timing of methylprednisolone or naloxone administration on recovery of segmental and long-tract neurological function in NASCIS 2. J Neurosurg 79 1993; 500-507
    CrossrefPubMedGoogle Scholar
  • 5 Bracken MB, Shepard MJ, Holford TR. et al Administration of methylprednisolone for 24 or 48 hours or tirilazad meslate for 48 hours in the treatment of acute spinal cord injury: results of the Third National Acute Spinal Cord Injury Study. JAMA 277 1997; 1597-1604
    CrossrefPubMedGoogle Scholar
  • 6 Agrawal SK, Fehlings MG. Mechanisms of secondary injury to spinal cord axons in vitro:role of Na+, Na (+)-K(+)-ATPase, the Na(+)-H+ exchanger, and the Na (+)-Ca2+ exchanger. J. Neurosci 1996; 545-552
    PubMedGoogle Scholar
  • 7 Agrawal S, Nashmi R, Feblings MG. Role of L and N type calcium channels in the pathophysiology of traumatic spinal cord white matter injury. Neuroscience 99 2000; 179-188
    CrossrefPubMedGoogle Scholar
  • 8 Aki T, Toya S. Experimental study on changes of the spinal-evoked potential and circulatory dynamics following spinal cord compression and decompression. Spine 09 1984; 800-809
    CrossrefPubMedGoogle Scholar
  • 9 Allen AR. Surgery for experimental lesions of spinal cord equivalent to crush injury of fracture dislocation of spinal column: a preliminary report. JAMA 57 1991; 878-880
    PubMedGoogle Scholar
  • 10 Burke DC, Berryman D. The place of closed manipulation in the management of flexion- rotation dislocations of the cervical spine. J Bone Joint Surg 53 B 1971; 165-182
    PubMedGoogle Scholar
  • 11 Maynard FM, Reynolds GG, Fountain S. et al Neurological prognosis after traumatic quadriplegia: three-year experience of California Regional Spinal Cord Injury Care System. J Neurosurg 50 1979; 611-616
    CrossrefPubMedGoogle Scholar
  • 12 Sonntag VK. Management of bilateral locked facets of the cervical spine. Neurosurgery 08 1981; 150-152
    CrossrefPubMedGoogle Scholar
  • 13 Katoh S, El Masry WS, Jaffray D. et al Neurologic outcome in conservatively treated patients with incomplete closed traumatic cervical spinal cord injuries. Spine 21 1996; 2345-2351
    CrossrefPubMedGoogle Scholar
  • 14 Kobrine Al, Evans DE, Rizzoli HV. Experimental acute balloon compression of the spinal cord: factors affecting disappearance and return of the spinal evoked response. J Neurosurg 51 1979; 841-845
    CrossrefPubMedGoogle Scholar
  • 15 Wiberg J, Hauge HN. Neurological outcome after surgery for thoracic and lumbar spine injuries. Acta Neurochir (Wien) 91 1988; 106-112
    CrossrefPubMedGoogle Scholar
  • 16 Bracken MB, Shepard MJ, Collins WF. et al A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury: results of the Second National Acute Spinal Cord Injury Study. N. Engl J. Med 322 1990; 1405-1411
    CrossrefPubMedGoogle Scholar
  • 17 Bracken MB, Holford TR. Neurological and functional status 1 year after acute spinal cord injury: estimates of functional recovery in National Acute Spinal Cord Injury Study II from results modeled in National Acute Spinal Cord Injury Study III. J Neurosurg (Spine 3) 96 2002; 259-266
    PubMedGoogle Scholar
  • 18 Fehlings MG, Sekhon LHS, Tator C. The Role and timing of decompression in Acute Spinal Cord injury. Spine 26 2001; 5101-5110
    PubMedGoogle Scholar
  • 19 Guttmann L. Spinal Cord Injuries: Comprehensive Management and Research 1976. 2nd . ed. 1976. Blackwell; Oxford:
    Google Scholar
  • 20 Frankel H, Hancock D, Hyslop G. et al The value of postural reduction in the Initial management of closed injuries of the spine with paraplegia and tetraplegia: Part I. Paraplegia 07 1969; 179-182
    CrossrefPubMedGoogle Scholar
  • 21 Bedrook GM. Spinal injuries with tetraplegia and paraplegia. J Bone Joint Surg 61 B 1979; 267-284
    PubMedGoogle Scholar
  • 22 Comarr AE, Kaufman AA. A survey of the neurological results of 858 spinal cord injuries: a comparison of patients treated with and without laminectomy. J Neurosurg 13 1956; 95-106
    CrossrefPubMedGoogle Scholar
  • 23 Tator CH, Duncan EG, Edmonds VE. et al Neurological recovery, mortality and length of stay after acute spinal cord injury associated with changes in management. Paraplegia 33 1995; 254-262
    CrossrefPubMedGoogle Scholar
  • 24 Wilmot CB, Hall KM. Evaluation of the acute management of tetraplegia: conservative surgical treatment. Paraplegia 24 1986; 148-153
    CrossrefPubMedGoogle Scholar
  • 25 Dall DM. Injuries of the cervical spine: II. Does anatomical reduction of the bony injuries improve the prognosis for spinal cord recovery?. S Afr Med J 46 1972; 1083-1090
    PubMedGoogle Scholar
  • 26 Harris P, Karmi MZ, McClemont E. et al The prognosis of patients sustaining severe cervical spine injury (C2–C7 inclusive). Paraplegia 18 1980; 324-330
    CrossrefPubMedGoogle Scholar
  • 27 Botel U, Glaser E, Niedeggen A. The surgical treatment of acute spinal paralysed patients. Spinal Cord 35 1997; 420-428
    CrossrefPubMedGoogle Scholar
  • 28 Fehlings MG, Cooper P, Errico T. Posterior plates in the management of cervical instability:long term results in 44 patients. J Neurosurg 81 1994; 341-349
    CrossrefPubMedGoogle Scholar
  • 29 Tator CH, Duncan EG, Edmonds VE. et al Comparison of surgical and conservative management in 208 patients with acute spinal cord injury. Can J Neurol Sci 14 1987; 60-69
    CrossrefPubMedGoogle Scholar
  • 30 Wilberger JE. Diagnosis and management of spinal cord trauma. J Neurotrauma 08 (Suppl. 01) 1991; 21-28
    PubMedGoogle Scholar
  • 31 Duh MS, Shepard MJ, Wilberger JE. et al The effectiveness of surgery on the treatment of acute spinal cord injury and its relation to pharmacological treatment. Neurosurgery 35 1994; 240-248
    CrossrefPubMedGoogle Scholar
  • 32 Tator CH, Fehlings MG, Thorpe K. et al Current use and timing of spinal surgery for management of acute spinal cord inkury in North America: results of a retrospective multicenter study. J Neurosur g (Spine) 71 1999; 12-18
    PubMedGoogle Scholar
  • 33 Chen TY, Dickman CA, Eleraky M. et al The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis. Spine 23 1998; 2398-2403
    CrossrefPubMedGoogle Scholar
  • 34 Aebi M, Mohler J, Zach GA. et al Indication, surgical technique and results of 100 surgically-treated fractures and fracture-dislocations of the cervical spine. Clin Orthop 203 1986; 244-257
    PubMedGoogle Scholar
  • 35 Benzel EC, Larson Sj. Recovery of nerve root function after complete quadriplegia from cervical spine fractures. Neurosurgery 19 1986; 809-812
    CrossrefPubMedGoogle Scholar
  • 36 Benzel EC, Larson SJ. Functional recovery after decompressive spine operation for cervical spine fractures. Neurosurgery 20 1987; 742-746
    CrossrefPubMedGoogle Scholar
  • 37 Vale FL, Burns J, Jackson AB. et al Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg 87 1997; 239-246
    CrossrefPubMedGoogle Scholar
  • 38 Pointillart V, Petitjean ME, Wiart L. et al Pharmacological therapy of spinal cord injury during the acute phase. Spinal Cord 38 2000; 71-76
    CrossrefPubMedGoogle Scholar
  • 39 Weinshel SS, Maiman DJ, Baek P. et al Effect of surgery on motor recovery following operative treatment. J Spinal Disord 03 1990; 244-249
    PubMedGoogle Scholar
  • 40 Croft TJ, Brodkey JS, Nulsen FE. Reversible spinal cord trauma: a model for electrical monitoring of spinal cord function. J Neurosurg 36 1972; 402-406
    CrossrefPubMedGoogle Scholar
  • 41 Kobrine Al, Evans DE, Rizzoli H. Correlation of spinal cord blood flow and function in experimental compression. Surg Neurol 10 1978; 54-59
    Google Scholar
  • 42 Dimar JR, Glassman SD, Raque GH. et al The influence of spinal canal narrowing and timing of decompression on neurologic recovery after spinal cord contusion in a rat model. Spine 24 1992; 1623-1633
    PubMedGoogle Scholar
  • 43 Wolf A, Levi S. Mirvis. et al Operative management of bilateral facet dislocation. J Neurosurg 75 1991; 883-890
    CrossrefPubMedGoogle Scholar
  • 44 Ahn JH, Ragnarsson KT, Gordon WA. et al Current trends in stabilizing high thoracic and thoracolumbar of spinal cord compression and decompression. Spine 09 1984; 800-809
    CrossrefPubMedGoogle Scholar
  • 45 Lee AS, MacLean JC, Newton DA. Rapid traction for reduction of cervical spine dislocations. J Bone Joint Surg 76 B 1994; 352-356
    PubMedGoogle Scholar
  • 46 Brunette DD, Rockswold GL. Neurologic recovery following rapid spinal realignment for complete cervical spinal cord injury. J Trauma 27 1987; 445-747
    CrossrefPubMedGoogle Scholar
  • 47 Waters RL, Adkins RH, Yakura JS. et al Effect of surgery on motor recovery following traumatic spinal cord injury. Spinal Cord 34 1996; 188-192
    CrossrefPubMedGoogle Scholar
  • 48 Anderson PA, Bohlman HH. Anterior decompression and arthrodesis of the cervical spine: long-term motor improvement: II. Improvement in complete traumatic quadriplegia. J Bone Joint Surg 74 A 1992; 683-692
    PubMedGoogle Scholar
  • 49 Burke DC, Berryman D. The place of closed manipulation in the management of flexion- rotation dislocations of the cervical spine. J Bone Joint Surg 53 B 1971; 165-182
    PubMedGoogle Scholar
  • 50 Schneider RC, Cherry G, Pantek H. The syndrome of acute central cervical spinal cord injury. J Neurosurg 1954; 546-577
    PubMedGoogle Scholar
  • 51 Schneider RC, Thompson JC, Bebin J. The syndrome of acute central cervical spinal cord injury. J Neurol Neurosurg Psychiat 21 1958; 216-227
    CrossrefPubMedGoogle Scholar
  • 52 Shrosbree RD. Acute central cervical spinal cord syndrome: Aetiology, age incidence and relationship to the orthopaedic injury. Paraplegia 14 1977; 251-258
    CrossrefPubMedGoogle Scholar
  • 53 Bridle MJ, Lynch KB, Quesenberry CM. Long term function following the central cord syndrome. Paraplegia 28 1990; 178-185
    CrossrefPubMedGoogle Scholar
  • 54 Newey ML, Sen PK, Fraser RD. The long-term outcome after central cord syndrome. J Bone Joint Surg 82B 2000; 851-855
    PubMedGoogle Scholar
  • 55 Bose B, Northrup BE, Osterholm JL, Cotler JM, DiTunno JF. Reanalysis of central cervical cord injury management. Neurosurgery 15 1984; 367-372
    CrossrefPubMedGoogle Scholar
  • 56 Brodkey JS, Miller Jr CF, Harmody RM. The syndrome of acute central cervical spinal cord injury revisited. Surg Neurol 14 1980; 251-257
    Google Scholar
  • 57 Dai L, Jia L. Central cord injury complicating acute cervical disc herniation in trauma. Spine 25 2000; 331-336
    CrossrefPubMedGoogle Scholar
  • 58 Bosch A, Stauffer ES, Nickel VL. Incomplete traumatic quadriplegia: A ten-year review. JAMA 216 1971; 473-478
    CrossrefPubMedGoogle Scholar
  • 59 Turnbull IM. Blood supply of the spinal cord: Normal and pathological considerations. Clin Neurosurg 20 1973; 56-84
    PubMedGoogle Scholar
  • 60 Bohlman HH, Freehafer A. Late anterior decompression of spinal cord injuries. J Bone Joint Surg 145 A 1979; 115-125
    PubMedGoogle Scholar
  • 61 Larson SJ, Holst RA, Hemmy DC. et al Lateral extracavitary approach to traumatic lesions of the thoracic and lumbar spine. J Neurosurg 45 1976; 628-637
    CrossrefPubMedGoogle Scholar
  • 62 Brodkey JS, Miller Jr CF, Harmody RM. The syndrome of acute central cervical spinal cord injury revisited. Surg Neurol 14 1980; 251-257
    Google Scholar
  • 63 Bohlman HH, Freehafer A, Dejak J. The results of treatment of acute injuries of the upper thoracic spine with paralysis. J Bone Joint Surg 67 A 1985; 360-369
    PubMedGoogle Scholar
  • 64 Cotler JM, Herbison GJ, Nasuti JF. et al Closed reduction of traumatic cervical spine dislocation using traction weights up to 140 pounds. Spine 18 1993; 386-390
    CrossrefPubMedGoogle Scholar
  • 65 Dall D.M. Injuries of the cervical spine: I Dose the type of bony injury affect spinal cord recovery?. S Afr Med J 46 1972; 1048-1056
    PubMedGoogle Scholar
  • 66 Bartholdi D, Schwab ME. Methylprednisolone inhibits early inflammatory processes but not ischemic cell death after spinal cord lesion in the rat. Brain Res 672 1995; 177-186
    CrossrefPubMedGoogle Scholar
  • 67 Chikawa T, Ikata T, Katoh S. et al Preventive effects of lecithinized superoxide dismutase and methylprednisolone on spinal cord injury in rats: transcriptional regulation of inflammatory and neurotrophic genes. J Neurotrauma 18 2001; 93-103
    CrossrefPubMedGoogle Scholar
  • 68 Hall ED. The neuroprotective pharmacology of methylprednisolone. J Neurosurg 76 1992; 13-22
    CrossrefPubMedGoogle Scholar
  • 69 King JS. Dexamethasone-a helpful adjunct in management after lumbar discectomy. Neurosurgery 14 1984; 697-700
    CrossrefPubMedGoogle Scholar
  • 70 Langmayr JJ, Ortler M, Obwegeser A. et al Quadriplegia after lumbar disc surgery. A case report. Spine 21 1996; 1932-1935
    PubMedGoogle Scholar
  • 71 Lavyne MH, Bilsky MH. Epidural steroids, postoperative morbidity, and recovery in patients undergoing microsurgical lumbar discectomy. J Neurosurg 77 1992; 90-99
    CrossrefPubMedGoogle Scholar
  • 72 Gendt SJ, Rodriquez JL, Pawlik JW. et al Consequences of high-dose steroid therapy for acute spinal cord injury. J Trauma 42 1997; 279-284
    CrossrefPubMedGoogle Scholar
  • 73 Tator CH, Rowed DW. Current concepts in the immediate management of acute spinal cord injuries. Can Med Assoc J 08 1979; 1453-1464
    PubMedGoogle Scholar
  • 74 Sugar O. Spinal cord malfunction after anterior cervical discectomy. Surg Neurol 1981; 15-48
    PubMedGoogle Scholar
  • 75 Bedbrook GM, Sakae T. A review of cervical spine injuries with neuorogical dysfunction. Paraplegia 02 1980; 45-61
    PubMedGoogle Scholar
  • 76 Hanigan WC, Anderson RJ. Commentary on NASCIS-2. J Spinal Disord 05 1992; 125-131
    CrossrefPubMedGoogle Scholar
  • 77 Hurlbert RJ. Methylprednisolone for acute spinal cord injury: an inappropriate standard of care. J Neurosurg (Spine1) 93 2000; 1-7
    CrossrefPubMedGoogle Scholar
  • 78 Bracken MB. Methylprednisolone and spinal cord injury. J Neurosurg (Spine1) 93 2000; 175-179
    CrossrefPubMedGoogle Scholar
  • 79 Bracken MB. The use of methylprednisolone. J Neurosurg (Spine 2) 93 2000; 340-341
    PubMedGoogle Scholar
  • 80 Bracken MB, Shepard MJ, Collins WF. et al A randomized controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med 322 1990; 405-1411
    CrossrefPubMedGoogle Scholar
  • 81 Brackem MB, Collins WF, Freeman DF. et al Efficacy of methylprednisolone in acute spinal cord injury. JAMA 251 1984; 45-52
    CrossrefPubMedGoogle Scholar
  • 82 Matsumoto T, Tamaki T, Kawakami M. et al Early complications of high-dose methylprednisolone sodium succinate treatment in the follow-up of acute cervical spinal cord injury. Spine 26 2001; 426-430
    CrossrefPubMedGoogle Scholar
  • 83 Galandiuk S, Raque G, Appel S. et al The two-edged sword of large-dose steroids for spinal cord trauma. Ann Surg 218 1993; 419-427
    CrossrefPubMedGoogle Scholar
  • 84 Molano M.R., Broton. Beak JA. et al Complications associated with the prophylaxic use of MP during surgical stabilization after spinal cord injury. J. Neurosurg (Spine) 96 2002; 267-272
    PubMedGoogle Scholar