An assessment of factors affecting neurological recovery after spinal cord injury with vertebral fracture.

In order to assess some of the variables associated with neurological recovery after traumatic spinal cord injury with vertebral fracture, a randomised sample of 100 patients (50 without neurological recovery, and 50 with several degrees of recovery) were selected out of 245 patients admitted to our hospital. Both groups were homogeneous with respect to time lapse to admission, hospitalization time and level of lesion. Of the variables considered, the intensity of the lesion (incomplete) and vertebral displacement (under 30%) were statistically associated with neurological recovery. An age under 30 years at the moment of the injury was also associated with neurological recovery but only in those patients with an incomplete lesion. No correlation was found between the other variables studied such as the degree of vertebral wedging, type of fracture (compression, flexion-rotation) and management (conservative, surgical) and the neurological evolution.

Tracheostomy ventilation versus diaphragmatic pacemaker ventilation in high spinal cord injury.

We have made a retrospective comparative study of patients with spinal cord injury, nine with a diaphragmatic pacemaker and 13 with mechanical ventilation. Clinical outcome, cost and subjective satisfaction with both modalities have been evaluated. The functional status was the same with both types of treatment. Proper management of an electric wheelchair and optimal phonation were attained, respectively, in 100% and 89% of pacers and in 77% and 77% of mechanically ventilated. The rate of hospital discharge and satisfaction with the treatment were significantly better for pacers. The time devoted to ventilatory assistance and cost were also more favourable in this group.

Outcome after vertebral fractures with neurological lesion treated either surgically or conservatively in Spain.

Out of 245 patients with spinal cord injury admitted to the Hospital Nacional de Paraplejicos of Toledo (110 treated conservatively, 135 treated surgically), randomised samples of 48 cases treated conservatively and 75 treated surgically were selected for comparison. Improved neurological status according to the Frankel scale was achieved in 37.5% after conservative treatment, and in 23% after surgery. Reduction and stabilisation were achieved by both conservative and surgical methods, and the functional outcome was the same for both treatments. The mean hospitalisation time was 198 +/- 10 (mean +/- SE) days for patients treated with conservative measures, and 222 +/- 9 days for patients treated surgically. No correlation was found between the type of fracture and severity of the neurological lesion. The neurological outcome by type of fracture was also similar for both treatments. No correlation was found between the degree of vertebral wedging and neurological evolution. Patients with greater vertebral displacement showed a worse neurological outcome. Taking both groups as a whole, incomplete lesions showed improvement in 66%, and complete in 14%. Neurological improvement after incomplete lesions was found in 87.5% of patients under 25 years of age and in 47% of those over 25 years. The poorest rate of improvement was found in those with thoracic lesions (17%), while those with cervical lesions improved most (48%). Furthermore, the neurological outcome in patients who were surgically treated within the first 24 hours after the injury was not statistically different from those who were treated later.