Tehran University Medical Journal (May 2023)
Investigating the effect of surgery time on improving the performance of fine movements of lower limbs in patients with traumatic spinal cord injury
Abstract
Background: Traumatic Spinal Cord Injury (TSCI) is one of the catastrophic events, the rate of which has been growing compared to the past decades. Complications caused by TSCI have a wide spectrum and can range from complete paralysis to numbness of the limbs. Additional to the injury severity and disability of the patient, the recovery rate depends on the treatment strategies. Despite extensive efforts and research in this field, there are still few treatment options for TSCI patients. Controversial results have been reported, however, spinal cord decompression is the only certainty for the treatment of these patients. In the present study, patients with thoracic and lumbar fractures were undergone decompression, less and more than 24 hours, and the recovery rate (RR) was compared after 6 months. Methods: In this study, patients with lumbar and thoracic fractures who were referred to the neurosurgery department of Ahvaz Golestan Hospital during May 2019 to December 2021 were included. Decompression was performed at the fracture level as a total and at the upper and lower levels of the fracture as a partial decompression. To evaluate fine motor movements, picking up a small object with toes and following a rectangular path were used. Also, the gross motor movements, upper and lower proximal and distal muscle forces were measured. Results: 160 patients including 133 men (83.1%) and 16.9% women (27) with 36±12 years mean age were included. The most fracture location was lumbar (53.1%), followed by the thoracic (43.1%) and fractures in both regions (3.8%). The most injured vertebras were L1 (27.5%) and T12 (18.8%). Six months later, 61.9% of patients had a good score for removing a small object with toe, of which 67.5% belonged to patients with<24 hours surgery (P=0.01). Also, RR for ability to follow a rectangle (P=0.017) and lower limit gross motor were significantly better in patients with<24 surgery (P=0.02). However, no significant difference was found between the two groups for improved sensations (P<0.05). Conclusion: This study showed that decompression<24 hours in TSCI is associated with a significant improvement in lower fine movements.
