Nerve root recovery in complete injuries of the cervical spine

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Yablon-I-G. Palumbo-O@Spatz-E. Mortara-R. Reed-J. Ordia-J. Department of Orthopedic Surgery, University Hospital, Boston, Spine. 1991 Oct. 16(10 Suppl). P S518-21. Thirty-six patients with complete quadriplegia were reviewed. Twenty-two underwent surgery, and 14 did not. There were 11 burst fractures and 3 extension fracture-dislocations, which were treated with anterior decompression and rigid plate fixation. There were 22 flexion injuries that were treated with posterior stabilization using Kirschner-wire tension band fixation, Harrington compression hooks, or Halifax laminar hooks. The non-operative group was treated with skeletal traction with skull tongs for 6-12 weeks followed by the application of a hard collar or halo vest for 3 months. Of the 22 patients who underwent surgery, 32% descended one level and 18% two levels. In the nonoperative group, only one patient descended one level. It is concluded that the heretofore pessimistic outlook regarding complete quadriplegia is unwarranted and that a more aggressive approach may result in a better functional outcome. Author-abstract.