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History :
The 50-year-old woman presented to Spine Fracture Specialist near Pune Dr. Sangram Rajale with severe left-sided back pain and going down to her left leg (radiculopathy) following a domestic slip and fall incident 15 days back.
She also experienced power loss in both lower limbs, tingling, and numbness sensations in her legs.
This power loss likely resulted from nerve compression or damage due to the spinal fracture.
The patient also experienced tingling and numbness sensations in her legs. These symptoms suggested nerve involvement and were commonly associated with spinal cord or nerve root compression, which could occur with vertebral fractures or spinal injuries.
MRI :
The MRI findings revealed a osteoporotic partial collapse of the D12 vertebra with marrow edema involving the vertebral body and pedicles.
Additionally, a small anterior epidural collection was seen causing diffuse cord compression. This collection resulted in compression of the spinal cord, leading to symptoms such as radiculopathy, numbness, tingling, and weakness in the lower limbs, which were observed as a loss of power during the examination.
DEXA SCAN
the DEXA scan result with a T score of -3.4 provided a crucial information that can help explain the reason for the fracture and subsequent spinal issues requiring surgery.
Likelihood of Spinal Fracture:
The combination of severe osteoporosis (as indicated by the T score) and the patient’s history of heavy object lifting and reported slip and fall incident likely contributed to the fracture of the D12 vertebra. The weakened bone structure couldn’t withstand the forces exerted during the fall or lifting, resulting in the partial collapse of the vertebra and subsequent spinal issues requiring surgical intervention.
Operation :
The surgery performed by Spine Surgery Specialist in Pune Dr. Sangram Rajale was a posterior spinal fixation from D10 to L2, including decompression of the D12 vertebra and fusion. This procedure was conducted under general anesthesia on January 28, 2023.
The implants used during the surgery included Kentro polyscrews of different sizes, connecting rods, and a cross-link connector.
The reason for this type of surgery was to address the post-traumatic/osteoporotic partial collapse of the D12 vertebra, along with the associated cord compression caused by the anterior epidural collection seen on the MRI. The fixation and fusion were aimed at stabilizing the spine and relieving pressure on the spinal cord, which in turn would alleviate the patient’s symptoms such as lower back pain, radiculopathy, and weakness in the legs.
Condition On Discharge :
The patient’s post-operative recovery and improvement in power are positive outcomes that align with the goals of the surgery.
Stable Post-Surgery Condition:
After the surgery, the patient remained stable, indicating that the procedure was successful in addressing the issues causing her symptoms.
Gradual Improvement:
Over the course of three months following the surgery, there was a significant improvement in the patient’s power, with an increase of around 4+/5 grade. This improvement suggests that the surgery effectively relieved pressure on the spinal cord and allowed for nerve recovery and function restoration.
Full Recovery:
By the fifth month post-surgery, the patient achieved full recovery. This means that she regained normal strength and function in her legs, indicating successful rehabilitation and healing of the spine.
The Need for Surgery:
The surgery was necessary due to several factors identified in the patient’s case:
Partial Collapse of D12 Vertebra:
The post-traumatic/osteoporotic partial collapse of the D12 vertebra was a significant concern. This condition can lead to instability in the spine, compression of nerves, and subsequent symptoms such as lower back pain, radiculopathy, and weakness in the legs.
Epidural Collection Causing Cord Compression:
The presence of an anterior epidural collection causing diffuse cord compression was another critical factor necessitating surgery. This compression can lead to severe neurological deficits, including weakness, numbness, tingling, and in severe cases, paralysis.
Failed Conservative Treatment:
It’s likely that conservative treatments such as medication, physical therapy, and rest were initially attempted but did not provide sufficient relief or improvement. In such cases, surgical intervention becomes necessary to address the underlying structural issues causing the symptoms. In summary, the surgery was essential to stabilize the spine, relieve cord compression, and restore neurological function. The positive outcome of full recovery indicates that the surgical intervention was successful in achieving these goals and improving the patient’s quality of life.