MANAGEMENT AND ITS PROGNOSTIC OUTCOMES IN FRACTURE THORACOLUMBAR SPINE WITH NEUROLOGICAL DEFICIT: A CASE SERIES
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Keywords
Thoracolumbar fracture, neurological deficit, pedicle screw fixation, spinal decompression, laminectomy, case series, spinal trauma, surgical outcomes.
Abstract
Thoracolumbar fractures with neurological deficits pose significant clinical challenges, often necessitating timely surgical intervention for spinal stabilization and neural decompression. This case series presents the clinical profile, surgical management, and neurological outcomes of four such patients treated with pedicle screw fixation at a tertiary care centre.
Case Presentation: Four patients presented with thoracolumbar fractures and varying neurological impairments due to traumatic falls. All underwent posterior pedicle screw fixation; and required additional decompressive laminectomy. Data were analyzed for preoperative status, intraoperative findings, postoperative recovery, and long-term outcomes.
Results: All patients exhibited clinical improvement. The young male with post-traumatic motor weakness showed progressive motor recovery with structured rehabilitation. The two elderly females experienced significant pain relief with stable and improved neurological function. The young female with motor weakness and bowel bladder involvement shows progressive improvement in her neurology and bowel bladder function. No perioperative complications occurred. At follow-up, all patients achieved functional independence with minimal residual deficits. The study underscored the pivotal role of preoperative neurological status , with patients presenting incomplete neurological deficit (ASIA C-D) exhibiting higher neurological improvement rate compared to those with near complete neurological injury (ASIA B).
Conclusion: Posterior pedicle screw fixation, with or without decompression, may be a viable and well-tolerated surgical approach for thoracolumbar fractures with neurological compromise. Early diagnosis, individualized surgical planning, and structured rehabilitation appear crucial to favorable outcomes. Individuals with higher neurological disability shows lesser improvement in post-operative period and vis-versa
References
2. Ghobrial GM, Jallo J. Thoracolumbar spine trauma: review of the evidence. J Neurosurg Sci 2013;57:115-22.
3. Ghobrial GM, Maulucci CM, Maltenfort M, et al. Operative and nonoperative adverse events in the management of traumatic fractures of the thoracolumbar spine: a systematic review. Neurosurg Focus 2014;37:E8.
4. Joaquim AF, Patel AA. Thoracolumbar spine trauma: Evaluation and surgical decision-making. J Craniovertebr Junction Spine 2013;4:3-9.
5. Katsuura Y, Osborn JM, Cason GW. The epidemiology of thoracolumbar trauma: a meta-analysis. J Orthop 2016;13: 383-8.
6. Wood KB, Li W, Lebl DR, et al. Management of thoracolumbar spine fractures. Spine J 2014;14:145-64.
7. Y.P. Charles, J.-P. Steib .Management of thoracolumbar spine fractures with neurologic disorder. Orthopaedics & Traumatology: Surgery & Research.2015;101(1); Pages S31-S40.
8. B.W. Chiles, P.R. Cooper Acute spinal cord injury N Engl J Med, 334 (1996), pp. 514-520.
9. B.K. Kwon, W. Tetzlaff, J.N. Grauer, et al. Pathophysiology and pharmacologic treatment of acute spinal cord injurySpine J, 4 (2004), pp. 451-464.
10. Qadir I, Riew KD, Alam SR, Akram R, Waqas M, Aziz A. Timing of surgery in thoracolumbar spine injury: impact on neurological outcome. Global Spine Journal. 2020 Oct;10(7):826
11. Naduvanahalli Vivekanandaswamy A, Kannan M, Sharma V, Shetty AP, Maheswaran A, Kanna RM, Rajasekaran S. Prognostic utility of magnetic resonance imaging (MRI) in predicting neurological outcomes in patients with acute thoracolumbar spinal cord injury. European Spine Journal. 2020 Jun;29:1227-35.
12. Durmaz MO, Ezgü MC, Karımzada DE, Karımzada G. MANAGEMENT OF THORACOLUMBAR FRACTURES: CLINICAL, FUNCTIONAL, AND RADIOLOGICAL OUTCOMES IN A SINGLE INSTITUTION. MANAGEMENT. 2023 Jul 27;34(3):124-30.
13. Muratore M, Allasia S, Viglierchio P, Abbate M, Aleotti S, Masse A, Bistolfi A. Surgical treatment of traumatic thoracolumbar fractures: a retrospective review of 101 cases. Musculoskeletal surgery. 2021 Apr;105:49-59.
14. Akay KM, Baysefer A, Kayali H, Beduk A, Timurkaynak E. Fracture and lateral dislocation of the T12-L1 vertebrae without neurological deficit--case report. Neurol Med Chir (Tokyo). 2003 May;43(5):267-70. doi: 10.2176/nmc.43.267. PMID: 12790289.
15. Mulumba Ilunga, R. , Diop, A. , Faye, M. , Nacoulma, V. , Akodjetin Mahougnon Sodjinou, N. and Codé Ba, M. (2021) Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature. Open Journal of Orthopedics, 11, 153-163. doi: 10.4236/ojo.2021.115015.
16. Zeng, J.F., Gong, Q., Liu, H., Rong, X. and Ding, C. (2018) Complete Fracture-Dislocation of the Thoracolumbar Spine without Neurological Deficit, a Case Report and Review of the Literature. Medicine (Baltimore), 97, e0050.
https://doi.org/10.1097/MD.0000000000010050.
17. Enishi, T., Katoh, S. and Sogo, T. (2014) Surgical Treatment for Significant Fracture-Dislocation of the Thoracic or Lumbar Spine without Neurologic Deficit: A Case Series. Journal of Orthopaedic Case Reports, 4, 43-45.
18. Kanna, R.M., Raja, D.C., Shetty, A.P. and Rajasekaran, S. (2021) Thoracolumbar Fracture Dislocations without Spinal Cord Injury: Classification and Principles of Management. Global Spine Journal, 11, 63-70. https://doi.org/10.1177/2192568219890568
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Dr. Kishor Navnathrao Sonwane
Junior Resident at Department of Orthopedics, Dr. Panjabrao Deshmukh Memorial Medical College And Hospital, Amravati
Dr. Ganesh Pundkar
HOD at Department of Orthopedics, Dr. Panjabrao Deshmukh Memorial Medical College And Hospital, Amravati
Dr. Rajendra W. Baitule
Professor at Department of Orthopedics, Dr. Panjabrao Deshmukh Memorial Medical College And Hospital, Amravati
Dr. Chaitanya Chikhale
Assistant Professor at Department of Orthopedics, Dr. Panjabrao Deshmukh Memorial Medical College And Hospital, Amravati
Dr. Amogh Bubna
Junior Resident at Department of Orthopedics, Dr. Panjabrao Deshmukh Memorial Medical College And Hospital, Amravati
Dr. Aman Rathod
Junior Resident at Department of Orthopedics, Dr. Panjabrao Deshmukh Memorial Medical College And Hospital, Amravati
