Late laminectomy in traumatic paraplegia.

Long-term observation in cases of spinal injury with subarachnoid block, treated by laminectomy and removal of compressing elements, shows worthwhile results in a good percentage. Twenty-seven cases of fractures of the spine at the dorsolumbar and lumbar levels with conus and cauda equina injury were treated by laminectomy and decompression from 6 to 12 weeks after the injury, and have been followed for periods of 3-27 years. Surgical intervention was offered only in those cases in which myelography demonstrated a subarachnoid block. Most of the cases were operated on at 6-12 weeks after the injury. Displaced laminae, thickened ligamentum flavum, and arachnoidal adhesions were the common causes of compression. In six cases there was also an arachnoid cyst. Long-term follow-up showed improvement in bladder function in 14 of 27 patients, and in motor function in 8 of 27. In dorsolumbar and lumbar injuries in which there is a subarachnoid block, decompressive laminectomy is a worthwhile procedure.