Surgical Outcome and Prognosis of Spinal Missile injuries

Background: The spinal cord is so sensitive to injury. Once it is damaged; it shall lose its ability to repair itself .Unfortunately spinal cord injuries (SCI)are common in Iraq . It could be either complete or incomplete SCI. In the complete injury there is a total loss of sensation and motor function in the level below the site of the injury, while in the incomplete one there is some remaining neurological functions below the level of the injury. Objectives: The aim of this study is to compare the surgical and conservative management of complete and incomplete spinal cord Injuries due to missile in Mosul city. Patients and methods: A case series study of (60) patients with missile cord injury of the spine who were managed in the Neurosurgical Department at Ibn-Sina Teaching Hospital in Mosul from August 2011 – August 2013. The mean patient age was 30 years. Thirty three (55%) patients were surgically treated. The mean time of follow up was 9 months ranged from 6-18 months. All patients had complete radiological assessment, CT scan and one patient with through and through bullet injury magnetic resonance imaging( MRI) was done after initial resuscitation. Results: All patients with complete spinal cord injury did not improved after non-surgical management, after surgical removal of bullet and it's pressure effect from the spinal cord just one case with conus medullaris injury gets improvement. Those with incomplete injuries show good improvement after surgical management. Conclusion: Conus medullaris and cervical injuries show a better outcome in surgical treatment than those out surgical intervention in incomplete spinal cord injuries. There were no difference between the outcomes of surgical and nonsurgical management of complete neurological injuries of the spinal cord.