Abstract
INTRODUCTION Penetrating Spinal cord injuries (pSCI) represent a small proportion of all Spinal Cord Injuries (SCI), but one with high morbidity. Relatively little is known about patterns of operative and nonoperative management of pSCI, or about its natural history following neurosurgical intervention. METHODS Data were abstracted from the North American Clinical Trials Network (NACTN) SCI registry. Chi square tests, T tests, and ANONVA were used to analyze the epidemiologic and clinical characteristics of patients who sustained pSCI, the timing and type of neurosurgical intervention performed, and ISNCSCI grade changes after injury. RESULTS Of 881 SCI enrolled in NACTN, 45 (5.1%) were penetrating. Compared with nonpenetrating SCI, pSCI patients were younger (28.8+10.1 years vs. 47.3+17.9 years SD), less likely to have cervical spine injuries (35.6% vs 76.2%) but more likely to have injury levels in the thoracic spine (64.4% vs 17.5%). The average ISNCSCI motor score in pSCI patients was 46+26.9; 62.2% were ISNCSCI grade A. They were less likely to have had radiographic (surgical) decompression of their spinal cord upon hospital discharge (31.8% vs. 83.7%). Surgery was performed in 27.8% (60% initially ISNCSCI A vs 47.2% in the nonoperative group, Chi square, P = .7391); of those 90% were radiographically decompressed at discharge. Eventual improvement of their ISNCSCI grade was seen in 50% (vs 8.3% of patients managed nonoperatively). Final ISNCSCI scores changed in 7 (15.6%) patients; 2 improved 2 grades, 3 improved one grade, another worsened a single grade, and one worsened by 3 grades). There was no association between initial injury level and change in motor score (P = .3066). CONCLUSION Penetrating spinal cord injuries are more common in younger people, and surgical decompression appears to be associated with an increased long term rates of AIS grade improvement.