Early surgery for thoracolumbar spinal cord injury: initial experience from a developing spinal cord injury centre in India

A four year experience treating incomplete thoracolumbar spine injuries in an East African country

Background

Traumatic spine injuries are one of the most common causes of disability and mortality.

Objective

To assess post op neurologic status in patients with incomplete thoracic and lumbar spine injuries at two teaching hospitals in Addis Ababa, Ethiopia.

Methods

Institution based retrospective cross-sectional study was conducted among 60 hospitalized patients in these hospitals from February 1, 2017-January 31, 2021.

Results

Forty five (75.0%) of the study participants were males. The mean age was 30.77 years (range: 12-65 year). Only 8(13.3%) patients were operated within 3 days of trauma. The most common injury site was the thoracolumbar junction (T11-L2) in 80.0%. Significant number of patients (56.7%) had sphincters dysfunction. Pedicle screw fixation with or without laminectomy was performed in 98.3%. After minimum six month follow up, 37(61.7%) patients had access to the physiotherapy. Thirty seven (61.7%) patients were non ambulatory (AIS B and C) at presentation, of which 29 (78.4%) were ambulatory on the follow-up. Overall, 54(90%) patients had neurologic improvement on the follow up and 37(61.7%) returned to work. Preoperative neurologic status and sphincter function were found to be significantly associated with treatment outcome with P value 0 .000 and 0.002 respectively.

Conclusion

This study shows despite limited availability of post op physiotherapy, significant number of patientsreturned to work post-surgery. Preoperative neurologic function was an independent predictor of post-operative outcome.

Tratamento cirúrgico da fratura toracolombar

INTRODUÇÃO: Várias são as causas responsáveis pelo atraso no diagnóstico da fratura toracolombar explosão, entretanto poucos trabalhos discutem a respeito do tratamento das fraturas operadas após algumas semanas do trauma. OBJETIVO: O objetivo deste estudo retrospectivo foi verificar o resultado do tratamento dos pacientes operados entre três a cinco semanas do trauma mediante artrodese e instrumentação metálica posterior. PACIENTES E MÉTODOS: De 1980 a 2004, excluindo as seqüelas ou fraturas recentes, 15 apresentaram um seguimento mínino de um ano. De acordo com a escala de Frankel, três dos cinco pacientes com alteração do quadro neurológico melhoraram (60%). RESULTADOS: Do ponto de vista clínico, 10 pacientes estão assintomáticos. Um apresentou infecção superficial e uma disfunção esfincteriana. Do ponto de vista radiográfico, a principal complicação encontrada foi a cifose no local da fratura, ocorrendo em cinco pacientes (33%). Houve piora média de 3 graus em relação ao valor da radiografia inicial. CONCLUSÃO: Acreditamos que, do ponto de vista da cifose no pós-operatório, a fratura toracolombar explosão subaguda deve ser tratada de forma distinta.

Timing of thoracic and lumbar fracture fixation in spinal injuries: a systematic review of neurological and clinical outcome

A systematic review of all available evidence on the timing of surgical fixation for thoracic and lumbar fractures with respect to clinical and neurological outcome was designed. The purpose of this review is to clarify some of the controversy about the timing of surgical fracture fixation in spinal trauma. Better neurological outcome, shorter hospital stay and fewer complications have been reported after early fracture fixation. But there are also studies showing no difference in neurological outcome when compared to late treatment. Mortality is another controversial point since a recent report of higher mortality in early treated patients. A systematic review of the literature was preformed. Ten articles were included. Early fracture fixation is associated with less complications, shorter hospital and ICU stay. The effect of early treatment on the neurological outcome remains unclear due to the contradictory results of the included studies. Early thoracic and lumbar fracture fixation results in improvement of clinical outcome, but the effect on neurological outcome remains controversial.

Treatment of L5-S1 Spondyloptosis With Single-Stage Surgery Through the Posterior Approach-Case Report-

A 21-year-old male patient with L5-S1 spondyloptosis was treated by total L-5 laminectomy with foraminotomy and posterior fusion through the posterior approach. His complaints of severe low back pain and limited spine mobility were resolved. No new deficits occurred. The surgical management of spondyloptosis includes one-, two-, or three-stage operations with posterior, anterior, or combined approaches. Careful posterior decompression and posterior fusion without reduction may be adequate for the treatment of L5-S1 spondyloptosis.

Adjacent fracture-dislocations of the lumbosacral spine: case report

OBJECTIVE AND IMPORTANCE

Traumatic fracture-dislocations of the lumbosacral junction are rare, with all previously reported cases involving fracture-dislocations at a single level. No cases of multiple fracture-dislocations of contiguous spinal segments in the lumbosacral spine have been reported. A case of traumatic adjacent fracture-dislocations of the fifth lumbar segment is presented.

CLINICAL PRESENTATION

An 18-year-old male patient sustained open lumbar spinal trauma after a motor vehicle accident. A neurological examination revealed an L4 level. Radiographic evaluation of the spine revealed a three-column injury at L5 with spondyloptosis of the L5 vertebral body. Aorto-ilio-femoral angiography revealed no evidence of vascular injury.

INTERVENTION

The patient was treated with a combined anterior and posterior approach in a two-stage operation. Six months postoperatively, he was neurologically unchanged; however, he was able to walk with the aid of a cane. Plain films revealed normal alignment of the lumbosacral spine.

CONCLUSION

The management of traumatic lumbosacral fracture-dislocations requires careful consideration of retroperitoneal structures and possible exploration of the iliac vessels in addition to spinal reconstruction.