The Journal of Bone and Joint Surgery, Vol 77, Issue 7 1042-1049, Copyright © 1995 by Journal of Bone and Joint Surgery, Inc
Pathophysiology of spinal cord injury. Recovery after immediate and delayed decompression
RB Delamarter, J Sherman and JB Carr
Department of Orthopaedic Surgery, University of California, Los Angeles School of Medicine, USA.
We evaluated the effect of the timing of decompression of the spinal cord
after compression of 50 per cent of the diameter of the spinal cord at the
fourth lumbar level in thirty purebred dogs. The dogs were divided into
five groups of six dogs each on the basis of the duration of the
compression. Decompression was performed immediately (Group I), one hour
(Group II), six hours (Group III), twenty-four hours (Group IV), or one
week (Group V) after the compression. Monitoring of somatosensory evoked
potentials, daily neurological examinations, and histological and electron
microscopic studies at the time of the autopsy were performed for all of
the dogs. Initially, all of the dogs were paraplegic after the compression
of the spinal cord. The dogs that had immediate decompression or
decompression after one hour of compression recovered the ability to walk
(grades 4 and 5, according to Tarlov's system) as well as control of the
bowel and bladder, and the somatosensory evoked potentials improved an
average of 85 and 72 per cent, respectively. However, when compression
lasted six hours or more, there was no neurological recovery and there was
progressive necrosis of the spinal cord. Somatosensory evoked potentials
improved 29 per cent in Group III, 26 per cent in Group IV, and 10 per cent
in Group V. The percentage of recovery of the somatosensory evoked
potentials by six weeks after the decompression was significantly related
to the duration of the compression (p < 0.0008).
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