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The patient came to the
emergency of Al-Shmaisani hospital
03-October-2008 after suffering RTA
02-October-2008 with clinical picture of
paraplegia at C6 level. |
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MRI of whole spine performed
today showing unstable fracture of C6 and
wedging of C7 with contusion and malacia of the
spinal cord at theses levels. |
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On examination: the patient
had complete paraplegia below D1 and severe
paresis below C5 and paraaneasthesia below D4
left side and D2 right side. |
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The patient was put under
observation for vital signs and massive dose of
decadron was started. |
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The next day before surgery
reevaluation confirmed improvement of the power
of upper limbs with the biceps 4/5 and grip of
the hands 3/5 and extension of the hands 3/5 and
triceps 2/5 both sides. |
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In supine position with halo
traction 5 Kg applied to the head, anterior
approach to C5 down to D1 was achieved.
Considering that the disci were in acceptable
position, it was decided not to violate them.
Check image-intensifier showed good reduction of
the fractured C6 and C7. |
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Using Hybrid miniplate 48 mm
length and 6 screws, fixation of C5, C7 and D1
was performed. The C6 was not included in screw
insertion to avoid bone dislodgment during screw
insertion. Serial check X-rays confirmed good
alignment and good positioning of the construct. |
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Routine closure of the wound.
The power of both upper limbs improved slightly
and the patient could feel the toes with crude
sensation better at the left side. |
