The Journal of Bone and Joint Surgery-American Volume. 77(7):1042–1049, JULY 1995
PMID: 7608226
Issn Print: 0021-9355
Publication Date: July 1995
Pathophysiology of Spinal Cord Injury. Recovery After Immediate and Delayed Decompression
Rick B. Delamarter;John Sherman;James B. Carr;
+ Author Information
Investigation performed at the Department of Orthopaedic Surgery, University of California at Los Angeles School of Medicine, Los Angeles.No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Funds were received in total or partial support of the research or clinical study presented in this article. The funding source was the Orthopaedic Research and Education Foundation and the Department of Health and Human Services Grant AM-2061 8-08.
Abstract
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).
