Evaluation of the acute management of tetraplegia: conservative versus surgical treatment.

A retrospective study of 106 tetraplegic patients admitted consecutively to the Santa Clara Valley Medical Center (SCVMC) between August, 1981 and September, 1983 was conducted. The average age was 28; and 20 (19%) were female. The majority sustained their spinal cord injury in a motor vehicle accident (65%) or in a diving accident (19%). Forty-nine percent (52/106) of these patients had acute surgical intervention, and 63% (33/52) of these patients had this prior to admission to SCVMC. The majority (35/52) had posterior fusion alone. Twelve patients had an anterior fusion (11 at other hospitals) and four a laminectomy alone (three carried out at other hospitals). The length of rehabilitation stay was 133 days for those having surgery, and 119 days for non-surgical cases; statistically a non-significant difference. When acute medical/surgical hospitalisation and rehabilitation days were combined, those having surgery had a significantly longer stay (197 versus 153 days), but only when surgery was done other than at SCVMC. Complications occurred in 50/106 (47%) of the patients: 50% who had surgery and 44% who were treated conservatively. The most commonest complication was respiratory (43%), including 20% who had pneumonia. Complications were no greater in those patients who underwent posterior fusion than in those who had no spinal surgery. However, other types of surgery carried a higher risk of complications by approximately 20%. Anterior fusions and laminectomies, performed almost totally at other institutions (15/17), had a higher rate of complications.