Spinal cord trauma: Predictive factors of long-term neurological recovery
Trauma raquimedular: Factores predictivos de recuperación neurológica a largo plazo
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Abstract
The spinal trauma (TRM) is the worst of those who survive. The losses in terms of independence are catastrophic. MRT predominates in young men.14 We intend to evaluate the main demographic aspects of MRT in our country and establish some predictable factors for long-term neurological recovery.3
Materials and methods: we reviewed the medical records and files of 173 patients with TRM. Of these, 131 (76%) were male and 42 (24%) female; The average age was 35.8 years.
Results: the time it takes for the patient to reach the hospital was less than 24 hours in 65% of the cases; 91 had traumas elsewhere in the body. The cervical spine is the most vulnerable segment (45.6% of the TRM). The average score on the Glasgow scale was 15. The mean arterial pressure was 93 mm Hg. The classification of the severity of the injury was made according to the criteria of the scale created by the American Spinal Injury Association (ASIA) finding complete injury, ASIA A in 40 patients (23.1%), and incomplete injuries, ASIA B in 8 (4.6%), ASIA C in 30 (17.3%) and ASIA D in 22 (12%). Seventy-three patients had no neurological deficit. Eleven required treatment in the intensive care unit (ICU), and in 19 (15%) the protocol of high doses of methylprednisolone was followed in the first eight hours posttrauma. Cephalic traction was used in 12% of patients; 36% suffered some kind of complication during hospitalization. The mortality was 5.2%. The follow-up period was six months. The degree of neurological recovery was also measured with the criteria of the ASIA scale and was higher in patients with incomplete lesions. 60% of patients with ASIA B on admission recovered a grade, 70% of patients with ASIA C recovered a grade and 50% of ASIA D patients recovered a grade after six months of trauma. The decrease in the level of consciousness, hypotension and the existence of a complete injury from admission, condition a poor long-term neurological recovery. The presence of complications also worsens the prognosis. Beneficial effects in recovery have been found in patients who received management in the ICU and in those who received high doses of methylprednisolone in the first eight hours.
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References
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