Abstract
Background: Traumatic paraplegia is an unanticipated catastrophe in an individual’s life, posing a huge economic as well as social burden. We evaluated all the patients for neurological improvement after surgical management of traumatic paraplegia in traumatic thoracolumbar fractures. Materials and Methods: The prospective study was conducted in the department of orthopedics of a tertiary care teaching institute in Kolkata, West Bengal, India. The patients were evaluated by X-ray of spine (anteroposterior and lateral view) and sometimes computed tomography scan. In most cases, pedicle screw with plate or rod was used and posterior stabilization and posterior fusion with corticocancellous bone graft from posterior iliac crest were done. Pre-operative and post-operative neurological charts (according to Frankel’s grade and American Spinal Cord Injury Association score [motor and sensory]) were maintained with regular assessment for proper post- operative neurological recovery assessment. Results: Forty-six patients in whom posterior stabilization of the spine was done in this institution and followed up for a period ranging from 6 months to 2 years, 4 of 46 patients lost follow-up. Remaining 42 patients were considered for the study. When decompression done within the 1st week in incomplete paraplegia, 80% of the patients show Grade 3 power return, whereas 25% of the patients show return of Grade 3 power when decompression done in the 3rd week in incomplete paraplegia cases. In complete paraplegia cases, 11% of the patients had return of power up to Grade 3 when decompression done within the 1 week, where no cases showed return of Grade 3 power when decompression done after the 2nd or 3rd week. In incomplete paraplegia, 80% of the patients had onset of sensory recovery within 1 week, when the decompression done within the 1st week. In complete paraplegia, 11% of the patients had sensory recovery within 2 weeks when decompression done within 1 week. Conclusion: Hence, our conclusion is that early decompression definitely has some role regarding motor and sensory function return, both in complete and incomplete paraplegia.
Highlights
IntroductionThoracolumbar junction is susceptible to injury and is the most commonly injured portion of the spine.[1,2] Once one spine injury is diagnosed, it is especially important to examine the rest of the spine since non-contiguous injuries can be present 15% of the time.[3,4] Three main categories with a common injury pattern were formed: Type A – vertebral body compression (compression force), type B – anterior and posterior element injury with distraction (tensile force), and type C – anterior and posterior element injury with rotation (axial torque).[4]
Thoracolumbar junction is susceptible to injury and is the most commonly injured portion of the spine.[1,2] Once one spine injury is diagnosed, it is especially important to examine the rest of the spine since non-contiguous injuries can be present 15% of the time.[3,4] Three main categories with a common injury pattern were formed: Type A – vertebral body compression, type B – anterior and posterior element injury with distraction, and type C – anterior and posterior element injury with rotation.[4]The treatment options for the unstable thoracolumbar spine fractures and fracture dislocations are ridden with controversies
We evaluated all the patients for neurological improvement after surgical management of traumatic paraplegia in traumatic thoracolumbar fractures
Summary
Thoracolumbar junction is susceptible to injury and is the most commonly injured portion of the spine.[1,2] Once one spine injury is diagnosed, it is especially important to examine the rest of the spine since non-contiguous injuries can be present 15% of the time.[3,4] Three main categories with a common injury pattern were formed: Type A – vertebral body compression (compression force), type B – anterior and posterior element injury with distraction (tensile force), and type C – anterior and posterior element injury with rotation (axial torque).[4]. We evaluated all the patients for neurological improvement after surgical management of traumatic paraplegia in traumatic thoracolumbar fractures. The cases included in this study were the patients attending outdoor and emergency with traumatic paraplegia involving the dorsolumbar spine. The presence of traumatic paraplegia (complete or incomplete) and fulfilled the following criteria: Fracture and/or dislocation of the vertebra of dorsolumbar spine involving D8-L5 spine. Fractures involving one or maximally two vertebrae Skin condition of the operative field normal patients and party agreed to has a surgical decompression. Neurological improvement after surgical management of traumatic paraplegia laminectomy was done for direct decompression. In these patients, we had to continue on conservative management and solid bony fusion developed between 12 and 20 weeks [Table 6]
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