Abstract

ABSTRACT Background: Cervical spine injury leads to significant functional impairment, one of them is quadriplegia. Debate between surgical versus conservative management of trauma to cervical spine has been going on since early 19th century. Aims &
Objective: This study has been conducted to compare functional and neurological outcome of conservative and operative management in patients with cervical spine injury with complete quadriplegia.
Materials and Methods: This was a retrospective study. Case records of 30 patients were analyzed. Patients were divided into 2 groups according to treatment given, i.e. Surgical and conservative. These two groups were compared retrospectively in terms of age, sex, type of injury, Mechanism of injury, mode of injury, stability, hospital stay, complications, neurological involvement and outcome. All patients were evaluated based on four parameters work, Functional independence measure, stability and neurological impairment. These parameters were measured and graded with appropriate modified scale.
Results: Mean age of patients in this study was 35 Yr. (Operative 31.88 Yr, Conservative 38.2 Yr.) With approximately 73 % belongs to 20 to 40 years group of young and active individual. Road traffic accident was the major culprit for cervical spine injury in this study. It accounts for 46.66% of total patients, followed by fall from height and fall of heavy object on patient. In operative group out of 15 patient 3 had stable cervical spine injury & 12 had unstable injury. In conservative group 5 had stable cervical spine injury and 10 had unstable cervical spine injury. Overall among 30 patient only 15 patient (50%) improve neurologically other remained same or worsened. Neurological improvement in conservative (46.66%) and operative (53.33%) group was found practically to be with negligible difference. Conclusion: The ultimate neurological and functional outcome of cervical injury was probably decided at time of injury itself rather than by chosen management. Improvement in neurological function was independent of factor like type of surgery, Mechanism of injury (flexion-extension), spinal deformity and type of management. Surgical stabilization result in batter alignment and stability, early rehabilitation and probably decrease in length of stay but has its own complication and great economic burden to patients.