Factors associated with improved neurologic outcomes in patients with incomplete tetraplegia

Spine (Phila Pa 1976). 2003 Jan 1;28(1):33-9. doi: 10.1097/00007632-200301010-00009.


Study design: Retrospective review of 412 patients with traumatic, incomplete, cervical spinal cord injuries, and an average follow-up period of 2 years.

Objectives: To determine what patient characteristics, injury variables, and management strategies are associated with improved neurologic outcomes. In particular, the effects of intravenous steroids (NASCIS II protocol), early definitive surgery (<24 hours after injury), early anterior decompression for burst fractures or disc herniations (<24 hours after injury), and surgical decompression for stenosis without fracture were assessed.

Summary of background data: Controversy surrounds the pharmacologic and surgical management of patients with spinal cord injuries.

Methods: Neurologic data were collected retrospectively and classified using American Spinal Injury Association guidelines. This information was recorded at the time of injury, on admission to rehabilitation, on discharge from rehabilitation, and at 1, 2, and final year of follow-up evaluation. Outcome measures included change in motor score, change in sensory score, final motor score, and final sensory score. The SPSS v10.0.7 statistical software package was used for data analysis.

Results: Neurologic recovery was not related to the following factors: gender, race, type of fracture, or mechanism of injury. Neurologic recovery also was not related to the following interventions: high-dose methylprednisolone administration, early definitive surgery, early anterior decompression for burst fractures or disc herniations, or decompression of stenotic canals without fracture. Improved neurologic outcomes were, however, noted in younger patients ( = 0.002), and those with either a central cord or Brown-Sequard syndrome ( = 0.019).

Conclusions: The most important prognostic variable relating to neurologic recovery in a patient with a spinal cord injury is the completeness of the lesion. When an incomplete cervical spinal cord lesion exists, younger patients and those with either a central cord or Brown-Sequard syndrome have a more favorable prognosis for recovery. In this study, no evidence was found to support high-dose steroid administration, routine early surgical intervention, or surgical decompression in stenotic patients without fracture.

Publication types

  • Comparative Study
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Age Factors
  • Brown-Sequard Syndrome / drug therapy
  • Brown-Sequard Syndrome / etiology
  • Brown-Sequard Syndrome / surgery
  • Decompression, Surgical / adverse effects
  • Decompression, Surgical / statistics & numerical data*
  • Follow-Up Studies
  • Humans
  • Intervertebral Disc Displacement / complications
  • Intervertebral Disc Displacement / diagnosis
  • Intervertebral Disc Displacement / drug therapy
  • Intervertebral Disc Displacement / surgery*
  • Male
  • Methylprednisolone / therapeutic use
  • Middle Aged
  • Neck Injuries / complications
  • Neck Injuries / diagnosis
  • Neck Injuries / drug therapy
  • Neck Injuries / surgery*
  • Neuroprotective Agents / therapeutic use
  • Outcome Assessment, Health Care*
  • Prognosis
  • Quadriplegia / drug therapy
  • Quadriplegia / etiology
  • Quadriplegia / surgery*
  • Recovery of Function
  • Retrospective Studies
  • Sample Size
  • Spinal Cord Injuries / complications
  • Spinal Cord Injuries / diagnosis
  • Spinal Cord Injuries / drug therapy
  • Spinal Cord Injuries / surgery*
  • Spinal Stenosis / complications
  • Spinal Stenosis / diagnosis
  • Spinal Stenosis / drug therapy
  • Spinal Stenosis / surgery
  • Time Factors
  • Trauma Severity Indices


  • Neuroprotective Agents
  • Methylprednisolone