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Pathophysiology of spinal cord injury. Recovery after immediate and delayed decompression

The Journal of Bone & Joint Surgery.  1995; 77:1042-1049 
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Abstract

We evaluated the effect of the timing of decompression of the spinal cord after compression of 50 per cent of the diameter of the spinal cord at the fourth lumbar level in thirty purebred dogs. The dogs were divided into five groups of six dogs each on the basis of the duration of the compression. Decompression was performed immediately (Group I), one hour (Group II), six hours (Group III), twenty-four hours (Group IV), or one week (Group V) after the compression. Monitoring of somatosensory evoked potentials, daily neurological examinations, and histological and electron microscopic studies at the time of the autopsy were performed for all of the dogs. Initially, all of the dogs were paraplegic after the compression of the spinal cord. The dogs that had immediate decompression or decompression after one hour of compression recovered the ability to walk (grades 4 and 5, according to Tarlov's system) as well as control of the bowel and bladder, and the somatosensory evoked potentials improved an average of 85 and 72 per cent, respectively. However, when compression lasted six hours or more, there was no neurological recovery and there was progressive necrosis of the spinal cord. Somatosensory evoked potentials improved 29 per cent in Group III, 26 per cent in Group IV, and 10 per cent in Group V. The percentage of recovery of the somatosensory evoked potentials by six weeks after the decompression was significantly related to the duration of the compression (p < 0.0008).

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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