Mrs. Khatun

July 14, 2023 By Dr. Sangram Rajale In Paraplegia, Thoracic Spine, Trauma, Osteoporosis

History :

A 52-year-old woman came to Fracture Spine Specialist in Pune Dr. Sangram Rajale with a reported incident of slipping and falling at home while lifting a heavy bucket of water about 25 days ago (on 03/06/2023).

Since then, she had been experiencing low back pain and weakness in both legs. She also complains of tingling and numbness in both legs.

She received initial treatment at another hospital and has now been referred to Orthopedic Spinal Surgeon in Pune Dr. Sangram Rajale for further care.

Before surgery, the patient had the following power (strength) in her legs assessment:

– Right Side (R) / Left Side (L)

– Grate Toe (EHL): 0/5 / 1/5

– Grate Toe (EDL): 0/5 / 1/5

– Ankle: Dorsiflexion (DF) 2/5 / Plantarflexion (PF) 4/5

– Knee: Flexion 3/5 / Extension 5/5

– Hip: Flexion 2/5, Abduction 2/5, Adduction 3/5 / 2/5, 3/5, 5/5

This assessment indicates varying degrees of weakness in different muscle groups and joints before the surgery.

RADIOLOGICAL INVESTIGATIONS:-

MRI of SPINE 

Indicates several changes related to lumbar spinal compression fractures:

Compression Fractures:

L1 Compression Fracture: This fracture at the L1 vertebra has resulted in the retropulsion (backward displacement) of the fractured part.

L1 Vertebral Body: There is a compression fracture with an anterior wedge collapse, meaning the front part of the vertebral body has lost height.

Old Fractures: There are also mentions of old anterior wedge collapse of the D6 and partial collapse of the D10 vertebrae.

These findings collectively suggest, compression fractures, and structural abnormalities in the spine, which can impact spinal stability, alignment, and overall function.

DEXA SCAN

  • A DEXA scan is a type of bone density test used to measure the strength and health of bones.
  • T Score: This score compares an individual’s bone density to that of a healthy young adult of the same sex. A T-score of -5.2 indicates significantly lower bone density compared to a healthy young adult, which is indicative of severe osteoporosis.
  • Z Score: This score compares an individual’s bone density to that of someone of the same age, sex, and size. A Z-score of -4.1 indicates lower bone density compared to people of similar age, sex, and size.
  • In summary, the DEXA scan results show severe osteoporosis based on the T-score, meaning the patient has very low bone density, and the Z-score indicates this is lower than expected for their age, sex, and size.

Operation :

The patient underwent a surgical procedure by Best fracture Spine Doctor in Pune Dr. Sangram Rajale involving fixation and fusion from the 11th thoracic vertebra (D11) to the 3rd lumbar vertebra (L3) using cement-augmented screws and rods under general anesthesia. The operating surgeon was Best Spine Specialist in Pune Dr. Sangram Rajale, and the implants used were from Pittkar.

Condition On Discharge :

  • Extensor Digitorum Longus (EDL) in both right and left sides improved from 1/5 to 1+/5.
  • Flexor Hallucis Longus (FHL) in the right side improved from 1/5 to 2/5, and in the left side improved from 1/5 to 1+/5.
  • Flexor Digitorum Longus (FDL) in the right side improved from 1/5 to 2/5, and remained at 2/5 in the left side.
  • Ankle Dorsiflexion (DF) in both right and left sides improved from 2/5 to 4/5.
  • Knee Flexion in both right and left sides improved from 3/5 to 5/5.
  • Hip Flexion in both right and left sides improved from 2/5 to 4/5.
  • Hip Abduction in both right and left sides improved from 2/5 to 4/5.

Decision in this case to not operate at the old fracture level

L1 Compression Fracture with L4-L5 PIVD (Posterior Intervertebral Disc):

The L1 compression fracture, along with the issue of a posterior intervertebral disc at the L4-L5 level, required surgery. This decision was likely made because the fracture and disc problem were causing significant symptoms or complications that necessitated surgical intervention to alleviate pain, stabilize the spine, and improve overall function.

In summary, the L1 compression fracture with L4-L5 PIVD required surgical treatment due to its severity and impact on spinal health, while the old compression fractures at D6 and D10 were managed conservatively because they were stable and not causing significant issues.