Analysis of 76 cases of acute spinal trauma at the Hospital San Juan de Dios, 1995-1997
DOI:
https://doi.org/10.51481/amc.v41i2.506Keywords:
trauma espinal agudo, metilprednisola, trauma, recuperación neurológica, inestabilidad espinal, fractura vertebralAbstract
Aim: To establish the most frequent trauma mechanism and clinical features o patients admitted for acute spinal cord injuries attended in the Neurosurgery Unit, San Juan de Dios Hospital, between 1995 and 1997.
Methods: A retrospective observational study was conducted on 76 consecutive patients admitted to the Neurosurgery Unit with or without an associatted neurological syndrome as a result of acute spinal cord injuries, betwen 1995-1997. All patients were evaluated at the time of admission and discharge from the institution, using the American Spinal Injury Association (ASIA) Motor Scale, a complete radiological evaluation and a clinical classification. In selected cases methylprednisolone was used following the recommendation given by in the NASCIS 2 study. Surgical intervention was performed in cases of spinal instability.
Results: Fifty-seven patients were men and 19 were women. The median age was 32.5 years. The leading cause of injury, in 47% of the cases, was fall or precipitation, followed by motorvehicle accidents in 26%. Thirty nine patients (51%) were admitted in ASIA grade E, 22 (29%) grade D, 7 (9%) grade C, one (1 grade B, and 7 (9%) grade A.
Methylprednisolone was used in 63% ofihe patients, and surgical approach was conducted in 32% of the cases. At the moment of discharge 80% were considered to be with ASIA grade E, 5 (7%) with grade D, 2 (3%) with grade C, and 4 remained with grade A. Four patients (5%) died.
Conclusion: The most frequent trauma mechanism and clinical features were established in all 76 patients with acute spinal injury, Wich is very useful for determining the correct approach for these patients, as well as preventing
further injuries. The patients submitted to a surgical intervention remained or at least improved one grade in ASIA scale. In patients receiving methylprednisolone, all with an ASIA grade C or higher improved in one or more grade, whereas the ones with lower grades remained the same or got worse. The mortality rate of ASIA grade A was 57. I %.
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