Abstract
Introduction
Late onset paraplegia due to spinal deformity heralds a progressive death of neurological function. Evidence suggests that decompression and deformity correction offers a promising result.
Aims
To analyze recovery patterns after surgery for late onset myelopathy.
Methods
25 consecutive patients were reviewed. Average age was 17.84yrs and duration of pre-operative deficit was 4.6months. 18 patients had paraparesis and 7 quadriparesis. The average JOA score was 4.85/17 in quadriparetic and 5.33/11 in paraparetic patients. The average Nurick's grade was 2.7. The average spasticity was 2.2 (1- 4) as per Ashworth scale. 13 patients had bladder dysfunction. Deformity apex was cervical, cervico-dorsal, upper-dorsal and dorsal in 5, 4, 2 and 14 patients. 19 had kyphosis and 6 had multi-planar deformity. Vertebral resection osteotomy was performed in 13 and decompression alone in 12. Methodology: The records were obtained from software Horizon CSR used to register all patients form 2000–2009. The final follow-up was obtained by direct patient interview in 11, telephonic interview 5 and via email in 9.
Results
At 1year, significant improvement in JOA scores were seen recovery patters. Of the2 patients, 2 patients, 14 had immediate recovery (4 Weeks), delayed recovery (4 -12 Weeks) was seen in 9 patients and 2 patients developed deterioration after surgery. Out of the 13 patients with bladder dysfunction, 2 developed worsening post surgery. Average Nurick's grade improved from 2.7 to 2.3. Complications: Pulmonary complications developed in 5 patients, 4 patients had wound dehiscence, 2 patients showed Myelopathy progression, 1 patient developed Brachial plexus paresis and progression of deformity was observed in 6 patients.
Conclusions
(1) Severity and duration of pre operative deficit correlate with neurological outcome (correlation coefficient(r value) = 0.72). (2) Safe correction of deformity provides a better mechanical and physiological environment for lasting results.