Traumatic myelopathy in patients with cervical spinal stenosis without fracture or dislocation: methods of diagnosis, management, and prognosis.

The New York University Spinal Cord Trauma Center recently completed an evaluation of 200 patients seen over a period of four years, from 1974 to 1978. A unique group of 23 patients with cervical spinal stenosis and myelopathy without fracture or dislocation was isolated. The presence of a narrow canal significantly influenced morbidity and prognosis. Based on a review of plain roentgenograms and myelograms, there were seven patients with an average age of 41 who had absolute low levels of narrowing of the spinal canal without evidence of degenerative changes. The remaining 16 patients, averaging 61 years of age, had superimposed spondylosis. In both groups, patients with the lowest anteroposterior diameters of the spinal canal had the most severe myelopathy after trauma. Patients with absolute stenosis were more susceptible to traumatic myelopathy than were those with relative stenosis. Varying the dose of steroids to maximal levels had no effect on prognosis. Patients showing improvement during the initial 48 hours had the greatest degree of eventual recovery.