[Posterior longitudinal myelotomy as a surgical treatment of acute cervical spinal cord injury].

Although it is of great tragedy to lose motor and sensory function of the spinal cord by spinal cord injury, there is no effective measure for complete cord lesions. In the central gray of the spinal cord at the region of injury, hemorrhagic necrosis and edema advance causing secondary damage to the spinal cord in rather early stage after injury. It has not been proved whether to remove necrotic tissue in the central gray matter can be effective to prevent secondary damage of the spinal cord or not. Operative result of six patients with acute physiologically complete cervical spinal cord lesion who have been subjected to posterior longitudinal myelotomy and removal of hematoma and necrotic tissue of the central gray of the spinal cord were evaluated. All of them admitted to Kitasato University Hospital within 24 hours after injury. They were five males and one female aged twenty to fifty-three. All the patients showed complete block of contrast medium on myelography at the level of one to two segments above the neurologically estimated level or injury of the spine, indicating marked swelling of the spinal cord. Average duration from injury to operation was sixteen hours ranging from six to thirty nine. Posterior longitudinal myelotomy was performed by using microsurgical technique. Skull traction was performed by using Crutchfield tongs for six weeks in five and twelve weeks in one of the patients. On admission forty mg of dexamethasone was used as steroid therapy followed gradual reduction.(ABSTRACT TRUNCATED AT 250 WORDS)