Abstract
About this talk
Neurological Recovery is not uncommon following tSCI & tCEI and is predictable. Neurological recovery depends on:
The quality of management of the multisystem physiological impairment and malfunction to prevent systemic and iatrogenic complications that cause further non-mechanical damage to neural tissues by destabilising the Physiologically Unstable Injured neural tissue.
The adequacy of the management of the Biomechanical Instability of the injured spine to prevent further mechanical damage of the neural tissue from bony or ligamentous structures.
The presence or absence of clinical signs of sensory or sensory motor sparing at and below the level of injury.
In the mid-sixties Frankel and colleagues made an astute observation that with what can be described as good Active Physiological Conservative Management of the injured spine, and the multisystem malfunctions and prevention of systemic complications; patients presenting within 14 days of injury with complete motor paralysis but sensory sparing made spontaneous motor recovery from reactivation of the myotomes adjacent to the functioning dermatomes irrespective of the radiological presentation on XRays of the injury on admission and on discharge. The same observations of the lack of correlation between the severity of the injury on CT and MRI scans and the neurological presentation and outcome have since been repeatedly demonstrated and published by El Masri et al and other experts in the field of Traumatic Spinal Cord and Cauda Equina injuries.
The unreliability of CT and MRI in predicting neurological status on admission and on discharge will be discussed. The prognostic indicators of neurological recovery, its extent and the factors that prevent neurological recovery or cause neurological deterioration will be discussed.
In the last four decades, routine surgical stabilisation and decompression have been carried out on patients with and without traumatic cord damage supported by assumptions based claims that surgical intervention is necessary to prevent neurological deterioration and enhance recovery.
Speaker
About the speaker
