Management of patients with an incomplete cervical spinal cord injury

Forty-five patients with incomplete cervical spinal cord injuries were examined as to the mechanism of injury, neurological deficits in the initial stage and differences in treatment. Nineteen (42.2%) were treated non-surgically and 26 (57.8%) surgically. Their injuries could be divided into seven types of cervical spinal cord injury according to Usui's classification. Neurological changes were evaluated with Frankel's grading system. The neurological prognosis was relatively better in those with a unilateral cord injury type, but there was no statistical difference. Thirty-seven patients (82.2%) showed neurological improvement of at least one Frankel grade. There was no statistical difference between the surgical and nonsurgical groups regarding neurological improvement, but all who underwent early surgery (within 4 weeks of being injured) improved. Surgical treatment was considered to be indicated for patients with cervical spinal canal narrowing, when satisfactory neurological improvement is not obtained by conservative treatment.