The patient came to the clinic 29-January-2007 after falling down 90 days ago from 150 cm height with resulting fracture L1 with compression of the spinal cord.

MRI performed 23-Jaunary-2007 showed resorption of L1 and fragments compressing the spinal cord with malacia of the spinal cord at that level.

On examination: the patient cannot walk, in wheelchair with pressure sores in the heel of the right foot. The left foot is amputated at 5 cm above the level of the toes 20 years ago. The patient is incontinent with cauda equina syndrome with anesthesia below both knees with weak both quadriceps 4/5 and adductors 4/5 and feet dorsi and planterflexion and abduction of the knees 0/5. She had agonizing pain when setting. The patient was sent for bone density study, which confirmed the presence of severe osteoporosis.

Conservative treatment started with Somazina, Nucleo-CMP, Nootropil, miaclacic nasal spray, Oscal-D and dorsolumbar support.
The patient came 05-March-2007 with new MRI showing the same picture, but the bone density study confirming slight improvement.
The patient came another time 06-June-2007 with new MRI performed 04-June-2007 showing the compression with malacia of the spinal cord.

On examination: slight improvement of the power of the left lower limb: the left quadriceps 5/5 and adductors 5/5 but the abductors 2/5 and 0/5 of feet dorsi and planterflexion. There was still anesthesia of the left lower limb 15 cm below the level of the knee. Bone density studies confirmed improvement of the bony structures strength.

It was explained to the relatives, that decompression is needed and the expected results are related to the degree of the spinal cord recovery. Stabilization of the area could arise during surgery.

Skeletonization of D12, L1 and 2 was performed. Check for stability, showed acceptable stable bony alignments. Laminectomy of L1 and partial of D12 and L2 was performed, trying during that to preserve the essential components providing the stability. Check for stability after decompression showed that the bony alignments having the same stability as before laminectomy. Plan for fixation was abandoned.

Smooth postoperative course, and the patient could move the feet dorsi and planterflexion.

The patient was not operated from the first visit, because she had severe osteoporosis and other medical problems. She came 90 days after the essential insult.

Surgery was not performed, only after long discussion with the relatives, that decompression could help in the process of improvement without any guarantee.

The necessity for fixation of the spine could be resolved only during surgery, which proved in this case unnecessary.