The role of decompression for acute incomplete cervical spinal cord injury in cervical spondylosis

Study Design. A prospective study was conducted in 37 patients with cervical spondylosis with incomplete cord injury to assess the role of decompression in these patients. Objective. To evaluate surgical and nonsurgical outcomes in patients with pre-existing cervical spondylosis of the spine, in whom an incomplete spinal cord syndrome developed after a minor neck injury. Summary of Background Data. The benefits of surgical treatment of incomplete cord injury with cervical spondylosis is controversial but remains a treatment option. The results of this study clarified the benefits of surgery in such patients. Methods. Radiographic findings and outcomes based on post-spinal injury motor function score were compared retrospectively in 37 patients with cervical spondylosis. Sixteen patients were treated operatively and 21 were treated nonoperatively. Results. The neurologic conditions of 13 of the 16 patients (81.2%) treated surgically improved within 2 days of surgery. Comparing the improvement of the two groups at defined intervals, there were statistically significant differences (P < 0.006) between the surgical and nonsurgical patients at 1-month and 6-month follow-ups. Nevertheless, 13 of the 21 patients (62%) treated nonoperatively had recovered to at least muscle Grade 3 at the 2-year follow-up, but their recovery was slower than that of the surgical group. Conclusion. Although neurologic improvement after an incomplete spinal cord injury when no bony lesion was present was slow during the first few months after trauma, more than 60% of the patients showed neurologic recovery with a muscle grade higher than 3 at 2-year follow-up. Surgical decompression, however, was associated with immediate neurologic improvement, faster recovery of neurologic function, early mobilization, better long-term neurologic outcome, briefer hospital stays, and fewer complications related to long confinements in bed than was nonoperative treatment.