Frankel, Paraplegia 1969 - The Value of Postural Reduction in the Initial Management of Closed Injuries of the Spine with Paraplegia and Tetraplegia. I
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The Value of Postural Reduction in the Initial Management of Closed Injuries of the Spine with Paraplegia and Tetraplegia. I
Frankel, Walsh, et al.·Paraplegia·1969·2,283 citations·Retrospective cohort
Frankel and colleagues reviewed closed spinal injuries with cord damage managed by postural reduction, relating the bony lesion and its reduction to neurological change.
Retrospective series of closed spinal injuries admitted to Stoke Mandeville within 14 days of injury, 1951 to 1968.
Methods
Design
Retrospective case series
Admitted March 1951 to August 1968
Patients
Closed spinal injuries with cord damage
Admitted within 14 days of injury
Adequate notes and X‑rays required
Stoke Mandeville Hospital
Basis
Motor and sensory function below the lesion
Graded on admission and at discharge
Injuries grouped as cervical, T1 to T10, T11 to L1, or lumbar
Key Findings
Late spinal instability developed in just 4 patients across the whole series treated by postural reduction.
Neurological recovery showed no correlation with the degree of bony reduction achieved.
Neither the type nor the degree of vertebral injury clearly correlated with the severity of the cord lesion.
Of 123 cervical patients admitted with complete lesions, 42 became incomplete to some degree.
Three cervical patients admitted with incomplete lesions became complete.
Board pearl
Grades C and D both have motor power below the lesion: in C it is of no practical use, in D it is useful, while B keeps sensation with no motor function.
Frankel grading of the neurological lesionFrankel, Paraplegia 1969
A
Complete: no motor or sensory function below the lesion
B
Sensory only: some sensation below the lesion, no motor function
C
Motor useless: motor function below the lesion, but of no practical use
D
Motor useful: useful motor power below the lesion
E
Recovery: no weakness, no sensory loss, no sphincter disturbance
Authors' conclusion
There is, however, no clear correlation between the types and degree of the vertebral injury and the severity of the neurological lesion, nor is there any correlation between the degree of reduction achieved and neurological recovery.
Frankel and colleagues reviewed closed spinal injuries with cord damage managed by postural reduction, relating the bony lesion and its reduction to neurological change.
Retrospective series of closed spinal injuries admitted to Stoke Mandeville within 14 days of injury, 1951 to 1968.
Methods
Design
Retrospective case series
Admitted March 1951 to August 1968
Patients
Closed spinal injuries with cord damage
Admitted within 14 days of injury
Adequate notes and X‑rays required
Stoke Mandeville Hospital
Basis
Motor and sensory function below the lesion
Graded on admission and at discharge
Injuries grouped as cervical, T1 to T10, T11 to L1, or lumbar
Key Findings
Late spinal instability developed in just 4 patients across the whole series treated by postural reduction.
Neurological recovery showed no correlation with the degree of bony reduction achieved.
Neither the type nor the degree of vertebral injury clearly correlated with the severity of the cord lesion.
Of 123 cervical patients admitted with complete lesions, 42 became incomplete to some degree.
Three cervical patients admitted with incomplete lesions became complete.
Board pearl
Grades C and D both have motor power below the lesion: in C it is of no practical use, in D it is useful, while B keeps sensation with no motor function.
Frankel grading of the neurological lesionFrankel, Paraplegia 1969
A
Complete: no motor or sensory function below the lesion
B
Sensory only: some sensation below the lesion, no motor function
C
Motor useless: motor function below the lesion, but of no practical use
D
Motor useful: useful motor power below the lesion
E
Recovery: no weakness, no sensory loss, no sphincter disturbance
Authors' conclusion
There is, however, no clear correlation between the types and degree of the vertebral injury and the severity of the neurological lesion, nor is there any correlation between the degree of reduction achieved and neurological recovery.