21-MAY-2026  RAJA SALEH WISHAH  50 YEARS   BURST UNSTABLE FRACTURE D7 WITH COMPRESSION AND MALACIA OF THE SPINAL CORD.

The patient came to the clinic 16-May-2026 complaining of midback pain after falling down 14-May-2026. She lost consciousness for seconds and got biparietal  subgalial hematoma. CT-scan done the same day showing as a minor fracture of D7 elsewhere.

On examination, the patient is not limping with severe back pain and difficult breathing. SLRS both sides was 80 degrees without pain and she is using dorso-lumbar corset.

MRI done 17-May-2026 showing burst fracture of D7 with bony compression and malacia of the spinal cord at this level. CT-scan also confirming this and ruling our rib fracture with intact lungs. MRI brain showed old changes of both occipital lobes not related to the recent injury. ESR was 110 mm/h and CRP was113.8 mg/L. The patient was started In antibiotic Samixon 1 gm twice daily and admitted 20-May-2026 for surgery the next day.

Prone position. The level of D7 was identified and skeletonization of D5-6-7-8 was done trying to preserve the interspinous and supraspinous ligaments.  All the posterior elements were intact. Taking this in consideration the old Harrington distraction-reduction concept was applied to this case. Using Nuvasive Armada laminal hooks 9 mm  4 pieces with hook set screws 4 pieces and to hook rods 5.5 mm  with step-wise distraction and reduction  was applied between D5 and D8. The lamina of D6 was avoided considering that the dorsal canal at this level is the most narrow in the dorsal spine. Using the C-arm the D7 regained normal appearance. Routine closure of the wound. The patient was sent to the ward.

Still early now.

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