MOTOR SEGMENTAL RECOVERY IN SPINAL CORD INJURY: A BLESSING IN DISGUISE!

Abstract

Our knowledge regarding neurological recovery following spinal cord injury is like a tip of an iceberg. Spinal cord does not regenerate once damaged but nerve roots do so if an optimum environment is provided. Although distal neurological recovery is unlikely in ASIA Impairment Scale A (complete lesions), root recovery at the site of injury can occur. ASIA has recognized Zone of partial preservation & Zonal segmental recovery below the neurological level. Such a recovery in motor functions (Motor segmental recovery-MSR) of lumbar roots in paraplegia may make all the difference in final outcome of ambulation & functional status of the patient.

100 Thoracolumbar injuries in ASIA A underwent surgery. In 60, Posterior instrumentation alone (Gp1) and in 40 posterior instrumentation with laminectomy (Gp2) was done. Results of these were compared with randomly picked up 100 similar cases treated conservatively (Gp3).

Meritsofsurgery(Gp1& Gp2)overconservative(Gp3) were many in terms of reduction & stability, pain-function scores, total hospital stay, ambulation mode and time. At 1 year follow-up, functional distal neurological recovery (FDNR) was said to be significant when ASIA A improved up to ASIA D/E and MSR was said to be significant (MSR-Sig) when key muscle had a power > III. In Gp3, FDNR was (7/100) 7% and MSR-Sig was (40/100) 40%. In Gp1 FDNR was(7/60) 11.67% and MSR-Sig (41/60) 68.33%. When laminectomy was added with instrumentation (Gp2) FDNR was (5/40) 12.5% and MSR-Sig was found in (37/40) 92% cases. This was especially beneficial in thoracolumbar injuries where MSR-Sig of the L2 & L3 roots made all the difference between an ambulatory life (with braces) and an otherwise permanent wheel chair bound life. Motor segmental recovery becomes a blessing in disguise in complete cases of spinal cord injury where distal recovery of spinal cord is unlikely to occur.