M A Hammoud1, F S Haddad, N A Moufarrij. 1. Department of Neurosurgery, University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
Abstract
BACKGROUND: Spinal cord injuries due to penetrating wounds are not uncommon. The management of these injuries remains controversial especially with regard to the effect of laminectomy on the neurological outcome. METHODS: Between 1980 and 1989, 64 patients injured by bullets and shell fragments to the spinal cord were reviewed. There were 58 males and 6 females: 24 injuries (37.5%) involved the cervical spine, 37 (57.8%) the dorsal spine, and 3 (4.7%) the lumbar spine. One group (group I) consisted of 47 patients (73.4%) who had immediate and complete sensorimotor loss of function. Another group (group II) contained 13 patients (20.3%) who presented with incomplete and non-progressive spinal cord deficit. One patient (1.6%) (group III) had progressive spinal cord deficit. Three patients (4.7%) (group IV) had injuries to the cauda equina. RESULTS: The results were analyzed using a chi-squared test when possible. In group I, 20 patients (42.5%) underwent laminectomy with no recovery, and 27 (57.5%) were treated conservatively, with 1 patient (3.7%) achieving marked improvement (p > 0.05). In group II, 3 patients (23.1%) underwent laminectomy with the 3 (100%) improved, and 10 patients (76.9%) were treated conservatively, with 8 (80%) recovering (p > 0.05). CONCLUSIONS: Our data in groups I and II agree with previously published literature that shows no significant advantage of performing laminectomies following penetrating spinal cord injuries. Moreover, group I patients had a poor prognosis whether laminectomy was done or not, and group II patients had a good prognosis whether laminectomy was done or not.
BACKGROUND:Spinal cord injuries due to penetrating wounds are not uncommon. The management of these injuries remains controversial especially with regard to the effect of laminectomy on the neurological outcome. METHODS: Between 1980 and 1989, 64 patients injured by bullets and shell fragments to the spinal cord were reviewed. There were 58 males and 6 females: 24 injuries (37.5%) involved the cervical spine, 37 (57.8%) the dorsal spine, and 3 (4.7%) the lumbar spine. One group (group I) consisted of 47 patients (73.4%) who had immediate and complete sensorimotor loss of function. Another group (group II) contained 13 patients (20.3%) who presented with incomplete and non-progressive spinal cord deficit. One patient (1.6%) (group III) had progressive spinal cord deficit. Three patients (4.7%) (group IV) had injuries to the cauda equina. RESULTS: The results were analyzed using a chi-squared test when possible. In group I, 20 patients (42.5%) underwent laminectomy with no recovery, and 27 (57.5%) were treated conservatively, with 1 patient (3.7%) achieving marked improvement (p > 0.05). In group II, 3 patients (23.1%) underwent laminectomy with the 3 (100%) improved, and 10 patients (76.9%) were treated conservatively, with 8 (80%) recovering (p > 0.05). CONCLUSIONS: Our data in groups I and II agree with previously published literature that shows no significant advantage of performing laminectomies following penetrating spinal cord injuries. Moreover, group I patients had a poor prognosis whether laminectomy was done or not, and group II patients had a good prognosis whether laminectomy was done or not.