Spinal cord injury in Vietnamese combat

Abstract

Observations on 114 Vietnamese combat injuries with spinal cord involvement treated from December 1965 to April 1969 are presented. Eighty (70%) of patients were under 24 years of age and 11 (9.6%) over 30 years; there were 79 (68%) clinically complete and 35 (31%) incomplete lesions; 61 patients had UMN lesions and 53 patients had LMN lesions. Fifty-seven patients received their injury by bullet wounds, the remainder largely by shell fragment, blast, or vehicle crash. Sixty-seven% of patients had multiple injuries with 43 chest injuries and 18 patients sustained gastrointestinal tract wounds. There were 16 renal injuries, one ureteral laceration and one ruptured bladder. Emergency therapy was rapidly performed in well-equipped hospitals. Evacuation was markedly enhanced by helicopter service. The renal injuries resulted in eight nephrectomies, one partial nephrectomy, and seven repairs with drainage. One hundred and seven patients underwent laminectomy, 90 for compound injuries. During the follow-up period G.U. complications found were: renal calculosis in 14 patients (13%); hydronephrosis in 20 patients (11.4% of kidneys in patients with LMN lesions, 4.7% of kidneys in patients with UMN lesions); lower urinary tract infection in 85 patients (80.2%); epididymitis in 14 patients (12.8%); PS pathology in 10 patients (8.8%); 'pseudopapillomata' in seven patients (three bladder, four urethra); bladder calculi in 56 patients (49.1%). Decubit and pain were frequent problems. Pain was treated by non-operative means. In regard to urological rehabilitation 67% to 78% (varying with lesion level) were catheter-free at the time of study with 53.5% of patients achieving this by 9 months post-injury. The procedures necessary to achieve this, including delayed intermittent catheterisation, are presented. Seventy-six patients (66.6%) had erections and 28 (24.5%) have been able to have relations. 42.1% of patients with clinically complete lower motor neuron lesions claimed psychic erections. At the time of the study 29 patients have returned to school and nine to gainful employment; 35 patients are still hospitalised and 27 are vocationally inactive. This did not vary with the lesion level. The length of hospitalisation is presented and contrasted with that of World War II and Korean paraplegics. 61.1% of patients required under 6 months of care at a spinal cord injury centre and only 29.4% (25 patients) required over 1 year of total hospitalisation.