Postoperative course of acute traumatic conus medullaris injury with complete injury

Abstract Study design: Retrospective clinical study.Objectives: To evaluate annual changes in the pathology of conus medullaris injury (CMI) and investigate its precise pathophysiology.Setting: Hospital in Iizuka, Japan.Methods: From January 2012 to January 2020, 16 individuals with complete spinal cord injury caused by vertebral fracture at the level of T12 or L1 were included in this study. We collected American Spinal Injury Association Impairment Scale (AIS), Lower-Extremity Motor Score (LEMS), and modified Frankel classification (mFr) data at admission and at 24 months postoperatively. Results: At the final evaluation, 3 of the 16 participants (18.75%) showed neurological improvement from AIS A to AIS C or D. Furthermore, LEMS significantly improved during the postoperative 24 months (p < 0.05). In the mFr, 12 of the 16 participants (75.0%) showed improvement. Moreover, three individuals (18.75%) acquired independent walking ability (higher than mFr D3) at 24 months postoperatively.Conclusion: Even in cases of complete CMI only, the recovery of lower extremity muscle strength varies among individuals.