Paraplegia in unstable thoracolumbar injuries. A study of conservative and operative treatment regarding neurological improvement and rehabilitation

Abstract

Thirty-seven patients with unstable thoracolumbar fractures and paraplegia were studied: 11 patients were given exclusively conservative treatment, 14 patients were treated conservatively after laminectomy with or without fusion, and 12 patients were treated with Harrington instrumentation. None of the 12 cases with complete paraparesis at admission to the hospital improved their neurological status. In patients with moderate and severe but not complete paraparesis one month after injury, the neurological improvement continued for several years and in many the neurological restitution was complete. There was no difference between the three treatment groups regarding the neurological improvement. A new Rehabilitation Index was constructed with special reference to paraplegic patients. One month after the injury the Rehabilitation Score in the Harrington group was considerably higher than in the other groups. After three months the score was equalized in the conservatively treated group and the Harrington group whereas the score of the laminectomy-fusion group remained lower as long as two years after injury. Thirty-two patients were followed-up two years after the injury. Irrespective of the treatment, 30 of 32 patients had reached their maximal ADL scores at the follow-up. In 19 patients the bladder function was satisfactory. Eleven patients could walk independently. Twelve patients used wheel-chairs. Twenty-eight patients managed outdoor transportation without help. Twenty-four patients (75 per cent) had returned to work. Complaints about back deformity, skin problems and pain at direct pressure over the fracture site were significantly more frequent in the conservative and laminectomy-fusion groups. The treatment with open reduction, fusion and stabilization with Harrington rods considerably reduced the immobilization and hospitalization time. The complications were few. - The Harrington operation resulted in an early rehabilitation, which is of great psychological importance for the patient. - Our study confirms the disadvantages of laminectomy followed by conservative treatment reported by other authors.