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23-MARCH-2009  JAMAL ALI HASAN  47 YEARS  RTA 1 WEEK AGO WITH FRACTURE DISLOCATION D3 AND PARTIAL OF D2 AND D4.

Anamnesis:

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The patient was transferred from Saudi Arabia 21-March-2008 to Shmaisani hospital after suffering RTA 5 days ago with a history of LOC for several hours and when awaked he was paraplegic below D2 both sides.

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MRI whole spine performed 21-March-2009 showed fracture dislocation of D3 with partial fracture of D2 and D4 with contusion and malacia of the spinal cord at these levels.

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On examination the vital signs were stable and the power of the upper limbs were normal. He has dense plegia below Th2 level with anesthesia at that level to pin-brick sensation. He had preserved sensation of position sense of the left foot manifesting the preservation of the left posterior funniculus of the spinal cord functionally.

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Exposure of the C7down to D5 laminae was performed with preservation of the intraspinous ligament. There was no tear of the D2-3-4 ligaments.

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Considering this, sublaminar hooks medium size were inserted under the C7 and D1 laminae, from the inferior border. Another four hooks were inserted below the D4 and 5 laminae from the upper border. The 2 rods were reconfigured so as to accept the normal alignment of the area. Fixation with distraction was applied to perform reduction of the bony alignments.

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Smooth postoperative recovery and the patient was sent back to the ICU.

Comments

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The patient has more than 90% of the spinal cord non-functioning at the damaged level. Aggressive medical treatment was started from the moment of admission and will be continued for 18-24 months to rescue the still surviving neural elements.

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The aim of surgery is to prevent further damage to the spinal cord and to ambulate the patient as soon as possible. It has no relation with the recovery of neural cells.

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