The results of treatment of acute injuries of the upper thoracic spine with paralysis.

We studied the cases of 218 patients who had had trauma to the upper region of the thoracic spine (first to tenth thoracic vertebra) that resulted in paralysis. Of these, 184 patients had a complete and thirty-four had an incomplete lesion of the spinal cord. Of the 184 patients who had a complete lesion of the spinal cord, none of the 149 patients who were followed for two to fifteen years recovered any significant neurological function, regardless of the type of operative or non-operative treatment. Thirty of the patients with an incomplete lesion of the spinal cord were followed for two to twenty years. Three others were lost to follow-up, and one died with ascending necrosis of the spinal cord and pulmonary failure three months after the laminectomy. Of the remaining thirty patients, twenty-three had an anterior cord syndrome, four had a central cord syndrome, and three had a Brown-Séquard syndrome. Five patients with an incomplete lesion were treated without surgery. Three of these patients recovered the ability to walk while two recovered some function but were still not able to walk. Seventeen patients with an incomplete lesion of the spinal cord were treated by laminectomy. Of these patients, two also had cord-cooling, two had a posterior fusion, and one had cord-cooling, spine fusion, and posterior instrumentation with Harrington rods. Five patients recovered partial ability to walk with braces, four did not, and eight lost neurological function or became completely paraplegic after surgery and did not recover. Eight patients with an incomplete lesion of the spinal cord were treated with anterior transthoracic decompression and fusion, three of whom had had a previous laminectomy that had not improved their status. Five patients recovered the ability to walk without aids, two walked with braces, and one recovered some motor function but was not able to walk. From this study, we concluded that laminectomy is contraindicated for incomplete lesions of the upper region of the thoracic spinal cord and that anterior transthoracic decompression and fusion offers the best chance of recovery of neurological function.