Title: Results of Spinal Fixation in Thoracolumbar Spine fractures with Spinal Cord Injury using the ASIA Impairement Scale
Authors: Dr Arnab Sinha, Dr Amit Kumar, Dr Santosh Kumar
DOI: http://dx.doi.org/10.18535/jmscr/v4i2.15
Spinal fixation provides stability to the vertebral column but the treatment of unstable fractures of thoracolumbar spine has long been controversial. Probably the best way is to understand that Vertebral column disruption with neurodeficit (signifying spinal cord injury) means there is spinal instability as it denotes a failure of the stabilizing role of the vertebral column. Neurological status in complete and incomplete lesions was compared as per ASIA Impairement Scale after 6 months of surgery. An effort was done to find the effect of spinal fixation in different types of vertebral and cord lesions in our scenario. On the analysis of our results we found out that most of the patients presented after 24 hours of injury and that there were a larger percentage of complete spinal cord lesions than incomplete spinal cord lesions. The postfixation neurorecovery results by a comparison of the ASIA Impairement Scale preoperative and six months postoperative showed that there was neither sensory nor motor recovery in any of the patients of complete lesion whereas there was variable amount of motor and sensory recovery in incomplete lesions. We had our share of complications too. There were three cases of superficial infections, (which resolved with medication and dressings uneventfully), two of peroperative dural tear (controlled uneventfully) and two cases of implant breakage. Spinal fixation, fusion and decompression may help in early neurological recovery in incomplete lesion. Even a small amount of recovery in any lesion is very useful to the patient. Even in cases where there is no neurorecovery, stabilization of the spine by spinal fixation helps in early mobilization in both incomplete as well as complete lesions which is necessary for physical and occupational rehabilitation.Proper patient selection, meticulous surgery and a knowledge of prognosis is important and goes a long way in patient as well as doctor satisfaction. A review of the available relevant literature was also done. Keywords- thoracolumber fractures, spinal cord injury, neurorecovery, ASIA Impairement Scale 1. Hughes JT. The Edwin Smith Surgical Papyrus: an analysis of the first case reports of spinal cord injuries. Paraplegia 1988;26(2) 2. Bagnall et al. "Spinal fixation surgery for acute traumatic spinal cord injury (Review)" Cochrane Database of Systematic Reviews 2008, Issue 1 3. Blackley HR, Plank LD, Robertson PA Regeneration of spinal cord J Spinal Disorder 1996 4. Limb VK Grab Crisco JJet al Arch Phys Med Rehab 2006;75 5. American Academy Lecture 1998 6. Osti D , Harms J, Farey ID, Int.Orthop. 1997 7. Rabel KA, zorilla P et al, Effects of decompression of cord on neurorecovery. Spine 1999; 24 8. Denis B,Holland NR et al Clin.Ortho. surgery vs nonoperaive treatment for unstable spine. 1999;289 9. Macevoy RV, Polk HC et al surgery for spinal stabilization Spine 1998,10 10. EpstainT, King HA et al Eur.spine J. 2007;32 11. Delphi convention 2002 time frame for surgical decompression afer spinal cord injury Spine 2011; 36 12. WilsonJR, et al Spinal Cord (2012) 13. McKinley W, et al, Arch Phys Med Rehab 2010 14. Vaccaro AR, Kim DH,Brodke DS. Diagnosis and management of thoracolumbar spine fractures JBJS 2011 15. Marshall et al. Deterioration following spinal cord injury A multicenter study Journal of NeurosurgeryMarch 1987 / Vol. 66 16. Sinha A The rationale of spinal fixation in SCI – A Review of literature. Journal of Bihar Orthopaedic Association XXVI Oct 2015 vol 2 17. Sinha A, Singh NN Current Concepts Regarding Timing of Surgery and role of decompression in spinal fixation of spinal cord injury patients: A Review of literature. J Adv Med Dent Scie Res 2015;3(6):S88-S91Abstract
References