Anterior Decompression of the Spinal Cord for Late Traumatic Paraplegia

Forty patients with late traumatic paraplegia were subjected to anterior decompression between Feb. 1978 and Nov. 1979. Thirty-five patients were followed up for 3 months to 2 years. There were 28 males and 7 females, age ranged from 22 to 55 years, The duration between injury and operation varied from 1 year and 3 months to 10 years and 8 months, The location of spinal fracture was between T₁₁ to L₂ in 34 patients and T_3～4 in one. Clinical symptoms of complete neurologic lesions were present in 11, and of incomplete lesions in 24. Laminectomy had been done previously in 29 patients. After admission, anterior decompression has been performed in all patients. The operative results were excellent in 3, good in 9, improved in 13, and in 10 the condition was unchanged. The results of the operation might be affected by several factors: （1） Incomplete neurologic lesions were far better in their response to the treatment than complete lesions. However, in 11 complete lesions there were 2 cases with good response and 4 cases improved after operation, This means that clinically complete neurologic lesions do not necessarily indicate anatomical transection of the spinal cord. （2） The lower the fracture site the better the functional recovery, indicating that in lower spinal fracture, it was the cauda equina which was involved. Evidently, compressed cauda equina would recover more easily than the spinal cord. （3） Patients who were oper- ated on 1～2 years after injury gave much better result than those operated 3～5 years after njury, Those operated on over 5 years after injury gave poor result. Although the prognosis of late traumatic paraplegia is usually poor and most surgeons consider that further operation would be unprofitable, it is still worth-while to perform anterior decompression in selected cases. In this article, 4 cases are reported in details, and the technique of adequate decompression is discussed.