History :
37 year old gentleman was brought to emergency department of with history of Road traffic accident due to hit by four wheeler while he was driving 2 wheeler on (25/1/23) at around 11 PM near Satara, After this he had severe pain in his back and was not able to move his both legs lower legs, he could not feel any sensations below umbilicus, he could not pass urine and was unable to walk. He was Admitted in outside hospital for 1 day then he was transferred Best Spine Hospital in Pune Dr. Sangram Rajale. During this accident he also had injury to his chest which was slowly getting filled with his own blood.Gradually he was loosing his control of urine and motion.He also had blood in his urin which was suggestive of some bladder injury.
On emergency basis we inserted an ICD to drain his blood from lungs.
ON EXAMINATION OF SPINE:-
These findings suggested a significant impairment of motor function and reflexes in the lower limbs, due to a the fracture affecting the spinal cord or peripheral nerves. The weakness extends from the hip down to the toes, affecting various muscle groups responsible for movement and stability. The brisk reflexes indicate an abnormality in the spinal cord or nerve pathways, leading to exaggerated reflex responses. The absence of response in the plantar reflex suggests dysfunction in the nerves responsible for this reflex arc.
Muscle Power:
Hip Muscles: 1/5 (very weak)
Knee Muscles: 1/5 (very weak)
Ankle Muscles:
Plantarflexion (PF): 0/5 (no movement or strength)
Dorsiflexion (DF): 0/5 (no movement or strength)
Toe Muscles (Extensor Hallucis Longus – EHL, Extensor Digitorum Longus – EDL, Flexor Hallucis Longus – FHL, Flexor Digitorum Longus – FDL): 0/5 (no movement or strength)
Reflexes:
Knee Reflex: Brisk (hyperactive)
Ankle Reflex: Brisk (hyperactive)
Plantar Reflex: Mute (absent response)
Overall, this neurological condition indicates a severe motor deficit in the lower limbs, impacting the patient’s ability to walk, stand, and perform daily activities requiring lower limb function.
MRI :
The MRI report are significant and likely contribute to the lower limb power loss experienced by the patient. The fractures and lung abnormalities can lead to pain, reduced mobility, and systemic complications, all of which may impact the function of the lower limbs and contribute to weakness or loss of power.
Fracture with retropulsion of L2 and L3 vertebra.
The MRI report indicates several significant findings related to the patient’s condition. Firstly, there is a fracture with retropulsion of the L2 and L3 vertebrae. This means that these vertebrae have fractured and displaced backward into the spinal canal, potentially causing compression or impingement on the spinal cord or nerves. Such fractures can lead to neurological symptoms, including lower limb weakness or paralysis.
Operation :
The operation performed on the patient involved a fixation fusion procedure from the L2 to L5 vertebrae, by which was conducted on January 28, 2023, under general anesthesia by Spine Injury Doctor in Pune Dr. Sangram Rajale . The implants used in the surgery were provided by Jayon and included the following:
- These implants were utilized to stabilize and fuse the L2 to L5 vertebrae, addressing the spinal issues identified in the patient’s condition.
- Fixation fusion involves securing the vertebrae together using screws and rods to promote spinal stability and facilitate bone fusion over time.
This procedure aims to alleviate pain, improve spinal alignment, and restore function for the patient.
Condition On Discharge :
- He was stable.
- Initially only slightly improved after the surgery was noted.
- He was ambulating on wheel chair and bed side sitting and bed side standing with support could be achieved till discharge.
- Around 15 days later he started showing significant improvement
- He regained his urine control after 1 month.And around 4 months later he was fully functional with walking without any support.
- He started his job around 5 months later.