Neurology

Traumatic spinal cord injuries (TSCI) are life-changing events. The medical, physical, psychological, social, financial, vocational, environmental & matrimonial effects also have an impact on the quality of life of the patient . The combination of consequent generalised physiological impairment, multi-system malfunctions, multiple disabilities, wide range of potential complications, sensory impairment together with the non-medical effects impose challenges to patients, carers and clinicians. Early prediction of neurological recovery is important to patients and family members especially during the early stages following injury.

 

Neurological Recovery is not uncommon following traumatic spinal cord damage and is predictable. With good simultaneous Active Physiological Conservative Management of the injured spine and the multisystem malfunctions all complications that can further damage the Physiologically Unstable injured cord (PUSC) can be prevented. Provided both the biomechanical instability and Physiological Instability of the injured cord are well contained to protect the cord from further mechanical and non mechanical damage most patients will exhibit a degree of neurological recovery. The magnitude and extent of this recovery depends on the presence or absence of sensory and sensory-motor long tract sparing in the first 48 hours of injury irrespective of the radiological presentation on Xrays, CT or MRI.

 

To date there is no evidence that surgical or non-surgical interventions on the injured spine and/or spinal cord add value to the neurological or other outcomes of patients with TSCI. The risks of further damage to the PUSC by a number of pathological mechanisms during surgery, post operatively as well as by non-operative management of the injured spine without adequate attention to all the malfunctioning systems of the body during the transition between the stage of spinal & neurogenic shock to return of reflexes can result in neurological deterioration, lack of expected degree of recovery or delays in recovery.

 

The positive and negative prognostic indicators of neurological recovery, and the factors that enhance, prevent or cause neurological deterioration in patients with complete and incomplete cord damage will be discussed.