gms | German Medical Science

58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)

Deutsche Gesellschaft für Neurochirurgie (DGNC) e. V.

26. bis 29.04.2007, Leipzig

Spinal cord compression: Prognostic relevance of surgery for the recovery of paraplegia

Prognose des Querschnittsyndroms bei spinalen Raumforderungen in Abhängigkeit vom Operationszeitpunkt

Meeting Abstract

  • corresponding author K. Kieselbach - Neurochirurgische Klinik, Klinikum der Stadt Nürnberg
  • G. Ranaie - Neurochirurgische Klinik, Klinikum der Stadt Nürnberg
  • C. R. Wirtz - Neurochirurgische Universitätsklinik, Heidelberg
  • K. Geletneky - Neurochirurgische Universitätsklinik, Heidelberg
  • A. Aschoff - Neurochirurgische Universitätsklinik, Heidelberg
  • H. H. Steiner - Neurochirurgische Klinik, Klinikum der Stadt Nürnberg

Deutsche Gesellschaft für Neurochirurgie. 58. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC). Leipzig, 26.-29.04.2007. Düsseldorf: German Medical Science GMS Publishing House; 2007. DocSO.01.07

Die elektronische Version dieses Artikels ist vollständig und ist verfügbar unter:

Veröffentlicht: 11. April 2007

© 2007 Kieselbach et al.
Dieser Artikel ist ein Open Access-Artikel und steht unter den Creative Commons Lizenzbedingungen ( Er darf vervielfältigt, verbreitet und öffentlich zugänglich gemacht werden, vorausgesetzt dass Autor und Quelle genannt werden.



Objective: The clinical outcome in patients with a spinal compressive process depends on a variety of factors, of which the extent of preoperative neurological symptoms and the early surgical intervention are of particular importance for the recovery. The critical time of an operation in acute paraplegic patients with regard to a complete recovery, however, remains unclear.

Methods: We retrospectively analysed 87 patients with complete paraplegia due to spinal space-occupying lesions (metastases 67%, neurinoma / meningeoma / chordoma 7%, epidural haematoma 13%, abscesses 14%). Surgical procedures included decompressions and (in)complete resections of tumours, drainage of abscesses and evacuation of the haematoma. The motor recovery (complete – partial – none) was analyzed in view of the time of intervention. The time intervals after the start of paraplegia were divided in 6 subgroups: 1 – 6 h, 7 – 12 h, 13 – 24 h, 24 – 48 h, <4 d, >4 d.

Results: A complete recovery of paraplegia was seen in 15 of 17 (88%) patients, who were operated within a period of 6 hours after the onset of symptoms. The longer the time – interval, the worse the capability to recover: in the second and third group just 62% resp. 25% of the patients attained normal motor function. In cases where the operation was performed 24 hours after the onset of paraplegia, just 8% of 26 patients in that group were symptom – free, 77% did not improve at all. However, the neurological status before the surgical intervention also determines the amount of postoperative recovery. In 57 patients with incomplete paraplegia, 60% showed no neurological deficits after 6 months. In contrast, just 40% of the paraplegic patients recovered completely. Interestingly, the approach, e.g. ventral or dorsal decompression, complete or incomplete resection, did not influence the results.

Conclusions: The aetiology of spinal compressive processes is heterogeneous and makes an assessment difficult. However, some of the factors clearly influence the prognosis. We could show that an operation within the first 12 hours after onset of paraplegia leads to a recovery in all cases, whereas after 48 hours, none of the operated patients achieved a complete regression. Nevertheless, there were also operations in unfavourable cases, which were able to prevent an irreversible loss of function.