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PubMed2005

Results of posterior surgery with intraoperative radiotherapy for spinal metastases.

OBJECT: Spinal cord compression from spinal metastasis represents a substantial clinical problem. Complete resection of spinal metastases is difficult in many cases, and conventional surgical decompression of the spinal cord with or without instrumentation often results in unsatisfactory neurological recovery and local recurrence, even if combined with external radiotherapy. To increase rates of local control and improve neurological recovery in such cases, we introduced decompressive surgery combined with intraoperative radiotherapy (IORT) for the treatment of spinal metastasis in 1992. We report the results of neurological recovery and local control in cases that received surgery with IORT. METHODS: Between November 1992 and December 2001, 133 cases (117 patients) were treated using IORT at Tokyo Metropolitan Komagome Hospital. The 79 cases (74 patients) that received posterior spine surgery only for spinal paresis due to spinal metastasis were reviewed. RESULTS: Improvement of at least one level according to Frankel's classification was attained in 68 cases (86%). Of the 58 patients unable to walk preoperatively, 45 patients (78%) regained walking ability postoperatively. Rate of local recurrence was 2.5%. CONCLUSIONS: IORT, combined with posterior surgery and FERT, might be one of the effective methods for local control of spinal metastasis and neurological improvement, especially in cases with progressive and multi-level lesions.

Adult↗

PubMed1999

The course of circulatory and cerebral recovery after circulatory arrest: influence of pre-arrest, arrest and post-arrest factors.

We evaluated the influence of pre-arrest, arrest and post-arrest factors on circulatory and neurological recovery for up to 1 year following circulatory arrest of cardio-pulmonary aetiology in 231 patients. Initially, all patients were unconscious and 106 had some cortical activity recorded in the immediate post-resuscitation EEG (Group I), while 125 had no such activity initially (Group II). The following variables were explored: age, sex, medical history, cause and location of arrest, initial cardiac dysrhythmia, duration of life support, metabolic acidosis, pulse-pressure product and heart pump function capacity early after resuscitation. Outcome measures were duration and quality of circulatory survival, cause of death, neurological recovery and ultimate outcome. First year survival was 33% in Group I and 16% in Group II. Severe heart failure and brain death occurred mainly in Group II. Circulatory recovery was negatively influenced by out-of-hospital arrest, metabolic acidosis and pulse-pressure products below 150. Neurological recovery was negatively influenced by initial dysrhythmias other than ventricular fibrillation, pulse-pressure products below 150, post-arrest heart failure and/or pulmonary complications. It seems that circulatory and cerebral outcomes are mainly determined by the global ischaemic insults sustained during the circulatory arrest period.

Aged↗

PubMedDate not supplied

Correlation of sequential MR imaging of the injured spinal cord with prognosis.

Forty-nine patients with acute spinal cord injuries were studied sequentially with MR imaging by using 0.5 Tesla superconductive units, and sequential MR changes were correlated with the prognosis of the patients. MR images were obtained within one week of the injury and then every two to six months when possible. The Frankel classification of neurologic function was correlated with MR findings. The most frequently observed types of signal intensity patterns on MR imaging were type 0 (isointensity on both T1- and T2-weighted images) and type I (isointensity on T1- and hyperintensity on T2-weighted images). In subsequent subacute and chronic stages, type II (hypointensity on T1 and hyperintensity on T2) was most frequently observed. The evolution of type 0 was to types I and II, whereas type I usually turned into type II or remained as type I. Type III (hyperintensity on T1 and hyper-, iso- or hypointensity on T2 images) patients were few in number. There was a good correlation between MR imaging patterns and neurologic recovery for initial and subsequent MR patterns, in that type 0 showed good recovery, whereas types I and II revealed good improvement or no recovery. In addition, the extent of the high signal intensity area on initial as well as on subsequent T2-weighted images was proportionally correlated to neurologic recovery. The degree of cord compression was also important for predicting recovery of neurologic function. Findings of MR imaging of acutely injured spinal cord suggested the prognosis of spinal cord injury, especially when sequential studies were obtained.

Acute Disease↗

PubMed2001

Postischemic (6-Hour) treatment with recombinant human tissue plasminogen activator and proteasome inhibitor PS-519 reduces infarction in a rat model of embolic focal cerebral ischemia.

BACKGROUND AND PURPOSE: The proteasome inhibitor PS-519 blocks activation of nuclear factor-kappaB, a major mediator of inflammation. We tested the hypothesis that combination treatment of recombinant human tissue plasminogen activator (rhtPA) and PS-519 extends the therapeutic window for treatment of stroke with rhtPA without increasing incidence of hemorrhagic transformation. METHODS: The middle cerebral artery (MCA) of male Wistar rats (n=56) was occluded by an embolus. After embolization, animals were randomly divided into the following groups: PS-519 treatment groups: PS-519 was given at 2, 4, or 6 hours after MCA occlusion; rhtPA treatment groups: rhtPA was given at 2 or 4 hours after MCA occlusion; combination treatment groups: PS-519 and rhtPA were given at 2, 4, or 6 hours after MCA occlusion; control group: the same volume of saline was given at 2 hours after MCA occlusion. RESULTS: Administration of PS-519 alone at 2 or 4 hours, but not 6 hours, significantly (P<0.05) reduced infarct volume and improved neurological recovery compared with the control group. Administration of rhtPA alone at 2 hours, but not 4 hours, significantly (P<0.05) reduced infarct volume and improved neurological recovery compared with the control group. Furthermore, combination treatment with rhtPA and PS-519 even at 6 hours significantly (P<0.05) reduced infarct volume, improved neurological recovery, and did not increase the incidence of hemorrhagic transformation compared with the control group or the group treated with PS-519 alone. CONCLUSIONS: Our data suggest that combination treatment with PS-519 and rhtPA extends the neuroprotective effect to at least 6 hours after embolization.

Acetylcysteine↗

PubMed2003

Spinal cord injuries from gunshot wounds to the spine.

Although vehicular trauma traditionally has accounted for the majority of spinal cord injuries, gunshot wounds are the second most common cause. Furthermore, the proportion of spinal cord injuries caused by gunshot wounds are increasing although the proportion of injuries caused by high-speed vehicular trauma is decreasing. Gunshot wounds to the spine commonly are thought to be stable injuries. There is, however, a potential for instability if the bullet passes transversely through the spinal canal and fractures pedicles and facets. Injuries to the thoracic region of the spine are the most common, followed by the thoracolumbar area and the cervical spine. Completeness of injury is related to the anatomic region. Patients with incomplete injuries and patients with injuries in the thoracolumbar region have the greatest improvement in motor function. Approximately (1/4) of individuals are able to ambulate 1 year after injury. Surgical decompression of bullets from the spinal canal has been shown to improve neurologic recovery below the T12 level. Improvement of neurologic recovery after bullet removal has not been shown in other regions of the spine. Rare instances of late neurologic decline because of retained bullet fragments have been documented.

Decompression, Surgical↗

PubMedDate not supplied

Clinical implications of headache in lacunar stroke: relevance of site of infarct.

OBJECTIVE: To assess whether the infarction topography influenced upon the incidence of headache and the likelihood of neurological recovery in lacunar infarction. BACKGROUND: The relationship between topography of infarction and the incidence of headache as well as the influence of headache on neurological outcome in patients with lacunar stroke are still unclear. METHODS: In a cohort of 387 patients with neuroimaging-proven acute lacunar infarction collected from a prospective hospital-based stroke registry over a 12-year period, 43 patients (11.1%) presented with headache within a 72-hour interval of stroke onset. RESULTS: Headache was more common in deep brain gray matter or brainstem lacunar infarction than in supratentorial white matter lacunar infarction (14.9% vs 8%, P < .033), but lacunar infarctions in the supratentorial white matter had less frequently absence of limitation at discharge (15.1% vs 25.1%, P < .013). In deep brain gray matter or brainstem lacunar infarction, early neurological recovery decreased from 26.2% to 19.2% when headache was present at stroke onset. In the multivariate analysis, dysarthria-clumsy hand and absence of headache in deep brain gray matter or brainstem lacunar infarction were independent predictors of favorable outcome. CONCLUSIONS: In patients with lacunar infarction, headache at stroke onset was more common in deep brain gray matter or brainstem topographies than in supratentorial white matter lesions. In deep brain gray matter or brainstem lacunar infarctions, early neurological recovery was less likely when headache was present.

Aged↗

PubMed1999

Hyperbaric oxygen therapy for massive arterial air embolism during cardiac operations.

BACKGROUND: Massive arterial air embolism is a rare but devastating complication of cardiac operations. Several treatment modalities have been proposed, but hyperbaric oxygen is the specific therapy. METHODS: The Israel Naval Medical Institute is the only referral hyperbaric center in this country for acute care patients. We reviewed our experience in the hyperbaric oxygen treatment of massive arterial air embolism during cardiac operations. RESULTS: Seventeen patients were treated between 1985 and 1998. Eight patients (47.1%) experienced a complete neurologic recovery; 6 patients (35.3%) remained unconscious at discharge, and 3 patients (17.6%) died. Mean (+/- SD) delay from the end of the operation to hyperbaric therapy was 9.6 +/- 7.4 hours (range, 1-20 hours). This delay was 4.0 +/- 3.4 hours (1-12 hours) for patients who had a full neurologic recovery, 12.8 +/- 7.1 hours (5-20 hours) for patients with severe neurologic disability, and 18.0 +/- 2.0 hours (16-20 hours) for patients who died (1-way analysis of variance; P =.002). The source of variance among the groups mainly resulted from the short delay for patients who experienced complete recovery compared with the other 2 groups (Tukey test). All 5 patients who were treated within 3 hours from the operation and 50% (2 of 4 patients) of those patients treated 3 to 5 hours from operation experienced a full neurologic recovery. With a delay of 9 to 20 hours, only 1 of 8 patients had a full neurologic recovery. The association between outcome and treatment delay was found to be statistically significant (tau = 0.65 with exact 2-sided P value =.0007). CONCLUSION: Hyperbaric oxygen therapy should be administered as soon as possible after massive arterial air embolism during cardiac operations.

Cardiac Surgical Procedures↗

PubMed2001

Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: a long-term follow-up study over 10 years.

STUDY DESIGN: A retrospective study was conducted. OBJECTIVE: To compare the long-term outcomes of subtotal corpectomy and laminoplasty for multilevel cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA: No study has compared the long-term outcomes between subtotal corpectomy and laminoplasty for multilevel cervical spondylotic myelopathy. METHODS: In this study, 23 patients treated with subtotal corpectomy and 24 patients treated with laminoplasty were followed up for 10 to 14 years after surgery. Neurologic recovery, late deterioration, axial pain, radiographic results (degenerative changes at adjacent levels, alignment, and range of motion of the cervical spine), and surgical complications were compared between the two groups. RESULTS: No significant difference in neurologic recovery was found between the two groups 1 and 5 years after surgery, or at the latest follow-up assessment. Neurologic status deteriorated in one patient of the subtotal corpectomy group because of adjacent degeneration, and in one patient of the laminoplasty group because of hyperextension injury. Axial pain was observed in 15% of the corpectomy group and in 40% of the laminoplasty group (P < 0.05). In the corpectomy group, listhesis exceeding 2 mm developed at 38% of the upper adjacent levels, and osteophyte formation at 54% of the lower adjacent levels. In the laminoplasty group, kyphotic deformity developed in one patient (6%) after surgery. In the corpectomy group, the mean vertebral range of motion had decreased from 39.4 degrees to 19.2 degrees (49%) by the final follow-up assessment. In the laminoplasty group, the mean vertebral range of motion had decreased from 40.2 degrees to 11.6 degrees (29%) by the final follow-up assessment. Neurologic complications related to the surgery occurred in two patients (one myelopathy from bone graft dislodgement and one C5 root palsy from bone graft fracture) of the corpectomy group and four patients (C5 root palsy) of the laminoplasty group. All of these patients recovered over time. The corpectomy group needed longer operative time (P < 0.001) and tended to have more blood loss (P = 0.24). Six patients in the corpectomy group needed posterior interspinous wiring because of pseudarthrosis. CONCLUSIONS: Subtotal corpectomy and laminoplasty showed an identical effect from a surgical treatment for multilevel cervical spondylotic myelopathy. These neurologic recoveries usually last more than 10 years. In the subtotal corpectomy group, the disadvantages were longer surgical time, more blood loss, and pseudarthrosis. In the laminoplasty group, axial pain occurred frequently, and the range of motion was reduced severely.

Aged↗

PubMed1990

GM1 gangliosides in the treatment of spinal cord injury: report of preliminary data analysis.

A prospective, randomized, placebo-controlled, double-blinded spinal cord injury GM1 ganglioside drug trial was completed. Of the 37 patients entered over a 16 month period, 34 patients (23 cervical and 11 thoracic injuries) received the test drug protocol and completed the one year follow up period. The neurologic recovery was quantified by serial measurement of the ASIA motor score throughout the acute hospital course and one year long follow up period. The primary variable used to assess neurologic recovery was the difference in the ASIA motor score from the admission value to the value at one year. The GM1 group had an average motor recovery of 36.9 points whereas the placebo group had an average change of 21.6 points (t-test difference, p = 0.088). Analysis of the secondary variable, the area under the ASIA motor score versus the logarithm of time, and the use of rank order nonparametric statistic on both the primary and secondary variables to sort neurologic recovery obtained similar statistical differences between the GM1 and placebo treatment groups. Randomization imbalances in baseline severity of injury and division of cervical and thoracic injury occurred in the trial. Because of this fact and the small sample size of the study verification of these results by a larger study is required.

Double-Blind Method↗

PubMed1993

MK-801 is neuroprotective but does not improve survival in severe forebrain ischemia.

The effects of MK-801 on postischemic recovery, survival and neuronal preservation in the cortex, hippocampus and striatum were studied in Mongolian gerbils. The drug was administered 30 min prior to 20 of min forebrain ischemia induced by bilateral ligation of the carotids. Neurological recovery and survival were monitored for 7 days. At the end of the monitoring period neuronal damage was analyzed in the brains of the survivors in both groups. Treatment with MK-801 did not improve either neurological recovery or end-point survival. However, significant (P < 0.01) neuronal protection was observed in the hippocampi and striata of the drug treated animals while cortical neurons were not significantly protected. These findings demonstrate that protection against ischemic neuronal damage can be observed without concomitant improvement in either postischemic neurological recovery or survival. Protection of selectively vulnerable brain regions, often used as the predictor of the therapeutic potential of an agent, does not appear to correlate well with postischemic survival in this animal model of ischemia.

Animals↗

PubMed2001

Treatment and outcome of 83 children with intraspinal neuroblastoma: the Pediatric Oncology Group experience.

PURPOSE: To investigate whether the rate of neurologic recovery or the incidence of long-term sequelae differed for children with neuroblastoma (NB) initially treated with chemotherapy versus surgical decompression with laminectomy, we reviewed the Pediatric Oncology Group (POG) experience. PATIENTS AND METHODS: A retrospective review of children diagnosed with intraspinal NB registered on POG NB Biology Protocol 9047 was performed. Survival, neurologic outcome, and orthopedic sequelae were evaluated according to age of the patient at diagnosis, stage of disease, duration and severity of neurologic symptoms, and therapeutic intervention. RESULTS: Between May 1990 and January 1998, 83 children with intraspinal NB were entered onto the study. Five-year survival for this cohort of patients was 71% +/- 9%. Forty-three (52%) of the patients had neurologic symptoms at diagnosis. After treatment, six of 15 severely affected patients, who presented with paralysis, completely recovered neurologic function. Two of five patients with moderate deficits, consisting of paresis and bowel/bladder dysfunction, completely recovered neurologic function. Seventeen of 22 assessable children, who had mild symptoms comprised of paresis alone, fully recovered. Seven of 24 assessable patients who had undergone laminectomy developed scoliosis, whereas spinal deformities were only detected in one of 49 assessable patients managed without laminectomy (P =.001). CONCLUSION: The frequency of complete neurologic recovery in children with intraspinal NB inversely correlated with the severity of the presenting neurologic deficits. The rate of neurologic recovery was similar for patients treated with chemotherapy compared to those managed with laminectomy. Fewer orthopedic sequelae were observed in the children managed with chemotherapy than were seen in children managed with laminectomy.

Adolescent↗

PubMed1988

[Morphofunctional evaluation of the condition of the brain in rats with different degrees of recovery of neurological status following arrest of systemic blood circulation].

The brain status was studied for four days after resuscitation of rats with different degrees of recovery of the neurological status after systemic circulatory arrest induced by the occlusion of vascular bundles of the heart. Morphometric analysis of the population of Purkinje cells from the two different functional zones of the cerebellum revealed that in comparison with completely recovered rats, the animals with disturbed neurological status were characterized by loss of neurons, disturbed composition of the neuronal population, development of severe dystrophic cell changes. The lateral zone of the cerebellum hemisphere was most affected. Four days after resuscitation all the animals showed a sharp increase in the size of the nucleus of Purkinje cells, which is considered to be one of the mechanisms of neuronal adaptation to hypoxia.

Animals↗

PubMed1984

Megadose corticosteroid therapy following experimental traumatic spinal injury.

Corticosteroids are frequently used in the treatment of spinal trauma, although neither experimental nor clinical evidence to support their use is persuasive. Recently there have been claims that extremely high doses ("megadoses") of corticosteroids (equivalent to 15 to 30 mg/kg of methylprednisolone) improve neurological recovery compared to results with traditional steroid doses. The authors have compared the effect of megadose dexamethasone and methylprednisolone therapy to that of saline treatment following traumatic cervical spinal injury in the cat. During 6 weeks postinjury, neurological recovery did not differ significantly in corticosteroid-treated and saline-treated animals. Moreover, histopathological changes in the spinal cord were similar in methylprednisolone- and saline-treated cats. Corticosteroid-treated animals had a higher mortality rate than did control animals, with the predominant cause of death being neurogenic pulmonary edema. It is concluded that megadose corticosteroid treatment does not improve neurological recovery in this experimental model of spinal injury, and is associated with increased mortality.

Animals↗

PubMed2003

Early recovery after cerebral ischemia risk of subsequent neurological deterioration.

Given the high short-term risk of stroke after transient ischemic attack, we hypothesized that substantial acute neurological recovery in patients presenting with cerebral ischemia would be associated with a greater risk of subsequent neurological deterioration due to recurrent cerebral ischemia. Data from the Trial of ORG10172 in Acute Stroke Treatment, a randomized trial of the heparinoid danaparoid, were analyzed to determine whether substantial acute recovery, defined as an improvement of greater than or equal to 75% on National Institutes of Health Stroke Scale (NIHSS) between baseline and 24 hours, was associated with a greater risk of subsequent deterioration, defined as a worsening on the NIHSS between day 1 and day 90. Of 1,184 subjects meeting entry criteria, 63 (5.3%) had substantial acute recovery. Subsequent deterioration was more common in those with substantial acute recovery compared with others (48 vs 33%; p = 0.028 by Fisher's exact test). In multivariable models, substantial acute recovery remained an independent predictor of subsequent deterioration (odds ratio, 3.0; 95% confidence interval, 1.7-5.2; p < 0.001). Among patients with acute cerebral ischemia, those who recover substantially within 24 hours may be at greater risk of subsequent neurological deterioration due to causes other than hemorrhage.

Aged↗

PubMed2005

Video-assisted thoracoscopic decompression of tubercular spondylitis: clinical evaluation.

STUDY DESIGN: A prospective, observational study using a novel procedure of video-assisted thoracoscopy and conventional, long spinal instruments for decompression of dorsal tubercular spondylitis. OBJECTIVES: To assess the efficacy of video-assisted thoracoscopic decompression of dorsal tubercular spondylitis and compare it with the published data of classic thoracotomy procedures. SUMMARY OF BACKGROUND DATA: Surgical decompression of dorsal tubercular spine with the transpleural transthoracic method is a standard procedure. It is a major surgery with significant morbidity in terms of blood loss, intensive care unit (ICU) and hospital stay, postoperative incision pain, and chest tube insertion. A procedure that has the potential to achieve comparable recovery in patients with dorsal tubercular spondylitis but with a surgery of lesser magnitude and morbidity has immense potential. METHODS: There were 16 patients with mid-dorsal tubercular spondylitis with paraplegia/paraparesis requiring surgery who were included in the study. Every patient had a recent paradiscal disease at a single level. A soft tissue shadow was visible on plain radiographs of the spine, and conservative treatment for at least 3 weeks had shown no recovery. Patients with obvious respiratory insufficiency and likely to have significant pleural adhesions were excluded from the study. Single lung anesthesia and ipsilateral lung collapse using a double-lumen tube were administered. A 3-portal thoracoscopy approach was used, and conventional but long spinal instruments were used through an open port to decompress the spine. Patients were assessed for blood loss, duration of surgery, postoperative incision pain, duration of chest tube insertion, ICU and hospital stay, and neurologic recovery. Patients were observed for a minimum of 6 months. RESULTS: Of 16 patients, 14 (88%) had good neurologic recovery. In 1 patient, thoracoscopy was abandoned, and open thoracotomy was performed because of persistent bleeding. Another patient did not recover, and anterolateral decompression was performed 10 weeks after thoracoscopy. She recovered subsequently. Other complications included fracture of the sixth rib in 1 patient and breakage of suction tip in another. Adequate tissue biopsy for histopathologic examination could be obtained in all patients. Duration of surgery was 223 minutes (+/-56), blood loss was 497 ml (+/-302), and blood transfusion was required in 3 patients (3 U in 1 and 1 U in 2). Postoperative analgesic (tramadol) was 243 mg (+/-70) for 2-4 days (median 3), median hospital stay was 5.5 days (range 4-9), chest tube requirement was 3 days (range 2-7), and 2 patients were required to stay in the ICU for 1 day each. CONCLUSION: Video-assisted thoracoscopic decompression of tubercular dorsal spondylitis is a viable option to achieve significant neurologic recovery with less morbidity, blood requirement, and hospital stay compared to the open thoracotomy procedures.

Adolescent↗

PubMed2004

Hypertonic fluid resuscitation from subarachnoid hemorrhage in rats.

OBJECTIVE: Increased intracranial pressure (ICP) and decreased cerebral blood flow leading to global cerebral ischemia are the primary causes of death after severe subarachnoid hemorrhage (SAH). Hypertonic saline has been demonstrated to exert neuroprotective properties after traumatic brain injury by osmotic mobilization of parenchymal water and improvement of microcirculation. We used a rat model to investigate the effects of hypertonic fluid resuscitation after SAH on ICP, cerebral blood flow, body weight, neurological recovery, and morphological damage. METHODS: Sixty rats were subjected to SAH induced by an endovascular filament. ICP and local cerebral blood flow were recorded continuously. Animals were assigned to three groups: 1) NaCl 0.9%; 2) NaCl 7.5% (4 ml/kg); and 3) NaCl 7.5% plus 6% dextran 70 (4 ml/kg) given 30 minutes after SAH. Body weight and neurological deficits were assessed daily. Morphological damage was evaluated on Day 7. RESULTS: SAH resulted in an immediate increase of ICP to approximately 60 mm Hg initially, and then to approximately 30 mm Hg for the next 90 minutes. Although NaCl 7.5% alone and in combination with dextran led to an immediate, significant, and lasting decrease of ICP to 15 to 20 mm Hg, only the combined therapy significantly increased body weight and improved neurological recovery. Furthermore, the group that received combined therapy exhibited significantly more surviving neurons in hippocampus, cortex, caudoputamen, and cerebellum. Mortality was reduced nonsignificantly, from approximately 65% in groups I and II to 35% in Group III. CONCLUSION: Treatment with NaCl 7.5% plus 6% dextran 70 is significantly effective for reducing the initial harmful sequelae of SAH. The regimen resulted in lowered ICP, improved neurological recovery, and less morphological damage after SAH in the rat.

Animals↗

PubMed1988

Neurologic injury and recovery patterns in burst fractures at the T12 or L1 motion segment.

Fourteen consecutive patients with burst fractures at T12 or L1, partial paralysis, and more than 30% canal compromise were prospectively evaluated pretreatment and posttreatment with roentgenograms to determine the initial fracture pattern, CT scans to determine the percent canal compromise and subsequent improvement, and a quantitative motor trauma index scale and bladder sphincter evaluation to determine neurologic recovery. The follow-up period averaged 32 months (range, 12-50 months). Treatment was as follows: nonoperative (three patients), Harrington rods and fusion (seven patients), and Harrington rods and fusion followed by anterior decompression and fusion (four patients). The initial severity of paralysis did not correlate with the initial fracture roentgenographic pattern or the amount of initial CT canal compromise. Neurologic recovery did not correlate with the treatment method or amount of canal decompression. Subsequent recovery did correlate with the initial fracture pattern. If the patient had a Type I or Type II fracture (both greater than 15 degrees kyphosis), greater than 90% neurologic recovery occurred, regardless of treatment. If the patient had a Type III fracture (less than 15 degrees kyphosis and the maximal canal compromise where bone encircles the canal) less than 50% neurologic recovery occurred. If the patient had a Type IV fracture (less than or equal to 15 degrees kyphosis and the maximal canal compromise at the level of the ligamentum flavum), the neurologic recovery was variable. Prognosis for neurologic recovery can be made based on initial roentgenograms. If greater than 15 degrees kyphosis is present, there is a good prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1982

Comparison of early and late naloxone treatment in experimental spinal injury.

The effects of early (1 hour posttrauma) and late (4 hours posttrauma) naloxone treatment on neurologic recovery were compared after experimental cervical spinal injury. Neurologic scores did not differ significantly between the early and late naloxone-treatment groups, and both naloxone groups showed significantly better neurologic recovery than saline-treated controls during a 6-week follow-up. These findings confirm the therapeutic benefit of opiate antagonists in experimental spinal injury and indicate that even delayed naloxone treatment is effective in improving neurologic outcome.

Animals↗