Efficacy of surgical decompression in regard to motor recovery in the setting of conus medullaris injury

J Spinal Cord Med. 2006;29(1):32-8. doi: 10.1080/10790268.2006.11753854.


Background/objective: An assessment of neurological improvement after surgical intervention in the setting of traumatic conus medullaris injury (CMI).

Methods: A retrospective evaluation of a cohort of patients with a blunt traumatic CMI from T12 to L1. The neurologic and functional outcomes were recorded from the acute hospital admission to the most recent follow-up. Data collected included age, level of injury, neurologic examination according to the Frankel grading system and motor index score, and the mechanism and timing of CMI decompression.

Results: A total of 24 patients with a mean age of 27 years (men, 87%) were identified. The most common level of bony injury was L1, and the most frequent mechanism of injury was a motor vehicle crash. Before surgical intervention, 16 of 24 patients (66.7%) had a complete neurological deficit below the level of injury. The median interval from injury to surgery was 6 days (range, 7 hours to 390 days). Decompression, fusion, and adjunctive internal fixation were the most common surgical procedures. Median length of follow-up was 32 months after surgery. Improvement in spinal cord and bladder function was seen in 41.6% and 63.6% of patients, respectively. Root recovery was seen in 83.3% of patients.

Conclusions: In the setting of CMI, no correlation between the timing of surgical decompression and motor improvement was identified. Root recovery was more predictable than spinal cord and bladder recovery.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Cohort Studies
  • Decompression, Surgical*
  • Female
  • Follow-Up Studies
  • Humans
  • Lumbar Vertebrae / injuries
  • Lumbar Vertebrae / surgery
  • Male
  • Middle Aged
  • Motor Neurons / physiology*
  • Muscle, Skeletal / innervation
  • Neurologic Examination*
  • Pain Threshold / physiology
  • Prognosis
  • Recovery of Function
  • Retrospective Studies
  • Spinal Cord / physiopathology
  • Spinal Cord / surgery
  • Spinal Cord Compression / diagnosis
  • Spinal Cord Compression / physiopathology
  • Spinal Cord Compression / surgery*
  • Spinal Cord Injuries / diagnosis
  • Spinal Cord Injuries / physiopathology
  • Spinal Cord Injuries / surgery*
  • Spinal Nerve Roots / injuries
  • Spinal Nerve Roots / physiopathology
  • Spinal Nerve Roots / surgery
  • Thoracic Vertebrae / injuries
  • Thoracic Vertebrae / surgery
  • Treatment Outcome
  • Wounds, Nonpenetrating / diagnosis
  • Wounds, Nonpenetrating / physiopathology
  • Wounds, Nonpenetrating / surgery*