DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20161797

Evaluation the results of surgical management of traumatic paraplegia in traumatic thoracolumbar fractures

Subarna Misra, Sukanta Sen, Sujoy Das, Abhishek Chatterjee, Aniruddha Sengupta, Suvasis Saha

Abstract


Background: Thoracolumbar spine fractures are common injuries that can result in significant disability, deformity and neurological deficit. Aim of this study was to evaluate the results of surgical management of traumatic paraplegia, complete or incomplete as classified by Frankel scoring.

Methods: A prospective study was conducted in patients attending outdoor and emergency department of Orthopedics of a tertiary care teaching institute in Kolkata, West Bengal with traumatic paraplegia involving the dorsolumbar spine. The important objectives are the time for recovery of various functions like sensory, motor and bowel and bladder function, comparison between early and late decompression, results of posterolateral fusion and time taken for solid bony fusion after operation. Total 46 cases were selected within a minimum of 6-month post-operative follow-up of which 4 cases lost in follow-up. Data collected from patient records included age, sex, time from injury to hospitalization, initial neurological status as per Frankel Score, MRI findings, surgery performed, postoperative course and neurological status at the time of discharge and latest follow up. Patients lost to follow up were not studied for outcome analysis.

Results: When decompression done within 1st week in incomplete paraplegia, 80% of the patients showed return of grade 3 power. In complete paraplegia cases, 11% of the patients had return of power up to grade 3 when decompression done within 1 week, where no cases showed return of grade 3 power when decompression done after 2nd or 3rd week.

Conclusions: After recovery from spinal shock, the earlier the surgical compression done, the better the neurological and bowel/bladder function recovery both in complete and incomplete paraplegic cases. Reduction is better and easy and less time consuming in early decompression than in late. Motor recovery can continue for over 6 months after decompression.


Keywords


Spinal cord injury, Traumatic paraplegia, Dorsolumbar spine, Decompression, Posterior fixation, Neurological deficit

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References


Rajasekaran S, Kanna RM, Shetty AP. Management of thoracolumbar spine trauma: An overview. Indian J Orthop. 2015;49(1):72-82.

Gertzbein SD. Scoliosis Research Society. Multicenter spine fracture study. Spine (Phila Pa 1976). 1992;17:528-40.

Gertzbein SD, Khoury D, Bullington A, St John TA, Larson AI. Thoracic and lumbar fractures associated with skiing and snowboarding injuries according to the AO Comprehensive Classification. Am J Sports Med. 2012;40:1750-4.

Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S. A comprehensive classification of thoracic and lumbar injuries. Eur Spine J. 1994;3:184-201.

Scivoletto G, Morganti B, Molinari M. Early versus delayed inpatient spinal cord injury rehabilitation: An Italian study. Arch Phys Med Rehabil. 2005;86:512-6.

Maynard FM Jr, Bracken MB, Creasey G, Ditunno JF Jr, Donovan WH, Ducker TB, et al. International standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Spinal Cord. 1997;35:266-74.

Aebi M, Etter C, Kehl T, Thalgott J. Stabilization of the lower thoracic and lumbar spine with internal spinal fixation system: indications, techniques, and the first results of treatment. Spine (Phila Pa 1976). 1987;12(6):544-51.

Benzel EC. Short segment compression instrumentation for selected thoracic and lumbar spine fractures: the short-rod/two claw technique. J Neurosurg. 1993;79:335-40.

Dolan EJ, Tator CH, Endrenyi L. The value of decompression for acute experimental spinal cord compression injury. J Neurosurg. 1980;53:749-55.

Maiman DJ, Larson SJ, Benzel EC. Neurological improvement associated with late decompression of the thoracolumbar spinal cord. Neurosurgery. 1984;14:302-7.

Vale FL, Burns J, Jackson AB, Hadley MN. Combined medical and surgical treatment after acute spinal cord injury: results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management. J Neurosurg. 1997;87:239-46.

Hugenholtz H, Cass DE, Dvorak MF, Fewer DH, Fox RJ, Izukawa DM, et al. High-dose methylprednisolone for acute closed spinal cord injury--only a treatment option. Can J Neurol Sci. 2002;29(3):227-35.

Bracken MB, Shepard MJ, Collins WF, Holford TR, Young W, Baskin DS, et al. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990;322(20):1405-11.

Steroids for acute spinal cord injury (Review). The Cochrane Collaboration; 2009.

Gerhart KA, Johnson RL, Menconi J. Utilization and effectiveness of methylprednisolone in a population-based sample of spinal cord injured persons. Paraplegia. 1995;33:316-21.

George ER, Scholten DJ, Buechler CM. Failure of methylprednisolone to improve the outcome of spinalcord injuries. Am Surg. 1995;61:659-63; discussion 663-4.

Gerndt SJ, Rodriguez JL, Pawlik JW, et al. Consequences of high-dose steroid therapy for acute spinal cord injury. J Trauma 1997; 42:279-284.

Bracken MB, Shepard MJ, Collins WF. A randomized, controlled trial of methylprednisolone or naloxone in the treatment of acute spinal-cord injury. Results of the Second National Acute Spinal Cord Injury Study. N Engl J Med. 1990;322(20):1405-11

Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res. 1984;189:65-76.

Denis F, Armstrong GW, Searls K, Matta L. Acute thoracolumbar burst fractures in the absence of neurological deficit (a comparison between operative and nonoperative treatment). Clin Orthop Relat Res. 1984;(189):142-9.

Kostuik JP. Anterior spinal cord decompression for lesions of the thoracic and lumbar spine, techniques, new methods of internal fixation results. Spine. 1983;8:512-31.

Bradford DS, McBride GG. Surgical management of thoracolumbar spine fractures with incomplete neurologic deficits. Clin Orthop Relat Res. 1987;218:201-16.

Bradford DS, Akbarnia BA, Winter RB, Seljeskog EL. Surgical stabilization of fracture and fracture dislocations of the thoracic spine. Spine. 1977;2:185-96.

Bohlman H.H. Bahniuk E. Raskulinecz G. Field G. Mechanical factors affecting recovery from incomplete cervical spinal cord injury: a preliminary report. Johns Hopkins Med J. 1979;145:115-25.

Transfeldt EE, White D, Bradford DS, Roche B. Delayed anterior decompression in patients with spinal cord and cauda equina injuries of the thoracolumbar spine. Spine. 1990;15:953-57

Mirza SK, Krengel WF, Chapman JR, Anderson PA, Bailey JC, Grady MS, et al. Early versus delayed surgery for acute cervical spinal cord injury. Clin Orthop Relat Res. 1999; 359:104-14.

Choe AS, Belegu V, Yoshida S, Joel S, Sadowsky CL, Smith SA, et al. Extensive neurological recovery from a complete spinal cord injury: a case report and hypothesis on the role of cortical plasticity. Front Hum Neurosci. 2013;7:290.

Taniguchi LU, Pahl FH, Lúcio J ED, Brock RS, Gomes M QT, Adoni T, et al. Complete motor recovery after acute paraparesis caused by spontaneous spinal epidural hematoma: case report. BMC Emergency Medicine BMC series ¿ open, inclusive and trusted 201111:10. Available at: http://bmcemergmed.biomedcentral.com/articles/10.1186/1471-227X-11-10.

Gorio A, Gokmen N, Erbayraktar S, Yilmaz O, Madaschi L, Cichetti C, et al. Recombinant human erythropoietin counteracts secondary injury and markedly enhances neurological recovery from experimental spinal cord trauma. Proc Natl Acad Sci USA. 2002;99:9450-5.

Anthony S. Burns, Colleen O'Connell. The challenge of spinal cord injury care in the developing world. J Spinal Cord Med. 2012;35(1):3-8.

McLain RF, Benson DR. Urgent surgical stabilization of spinal fractures in polytrauma patients. Spine; 2004:1646-1654.

Vauzelle C, Stagnara P, Jouvinroux P. Functional monitoring of spinal cord activity during spinal surgery. Clin Orthop Relat Res. 1973;93:173-8.