Revision surgery effectiveness in late thoracolumbar junction traumatic injury

Abstract

Traumatic injuries of the spine constitute a relatively small part of the consequences of the traumatic factor action on the human body but they significantly affect the social and economic component of the injured patients’ life. During the Russian-Ukrainian war, the number of patients with traumatic injuries to the spine and spinal cord increased significantly. The analysis of previous armed conflicts shows that most spinal injuries in both military and civilians are closed. Therefore, the treatment strategy correspond to those in peacetime. One of the least studied issues is the feasibility of surgical decompression of the spinal canal in the late period of spinal cord injury.
An anamnestically complex case of traumatic injury of the thoracolumbar junction is presented. A patient with a combined injury underwent laminectomy of the Th12 vertebra and transpedicular fixation of the Th11, Th12, L1 and L2 vertebrae after fracture-dislocation of the Th12-L1, that was accompanied by gross neurological symptoms of ASIA A. Surgery was performed 11 days after the emergency hospitalization. 6 months after trauma it was revealed the screws malposition in the bodies of the Th12 and L1 vertebrae. After 10 months, a surgery was performed: removal of the left transpedicular screw from the body of the Th12 vertebra, laminectomy of the Th12, L1 and L2 vertebrae, an electronic neurostimulator was installed on the spinal cord, and 12 months after the injury, the transpedicular stabilization system was rearranged and the electrodes of neurostimulator were removed. Within 3 years and 7 months, after the appearance of acute pains in the area of the kidneys, an additional examination was performed. Fragmentation of the left rod of fusion system between the L1 and L2 vertebrae was revealed, as well as the presence of ossified fragments of the intervertebral disc at the Th12-L1 level, which caused absolute stenosis of the spinal canal. In Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine, revision surgery was performed: adequate repositioning of the stabilization system and extensive decompression of the spinal canal with facetectomy and complete decompression of the dural sac. During the follow-up examination after 4 months, regression of the neurological deficit from ASIA A to ASIA B was recorded.
In the article classic errors during surgery of traumatic injuries of the thoracolumbar junction and the expediency of performing decompressive-revision surgical interventions in the late period of spinal cord injury were analyzed.

An anamnestically complex case of traumatic injury of the thoracolumbar junction is presented. A patient with a combined injury underwent laminectomy of the Th12 vertebra and transpedicular fixation of the Th11, Th12, L1 and L2 vertebrae after fracture-dislocation of the Th12-L1, that was accompanied by gross neurological symptoms of ASIA A. Surgery was performed 11 days after the emergency hospitalization. 6 months after trauma it was revealed an unsatisfactory location of the screws in the bodies of the Th12 and L1 vertebrae. After 10 months, a surgery was performed: removal of the left transpedicular screw from the body of the Th12 vertebra, laminectomy of the Th12, L1 and L2 vertebrae, an electronic neurostimulator was installed on the spinal cord, and 12 months after the injury, the transpedicular stabilization system was rearranged and the electrodes of neurostimulator were removed. Within 3 years and 7 months, after the appearance of acute pains in the area of the kidneys, an additional examination was performed. Fragmentation of the left rod of fusion system between the L1 and L2 vertebrae was revealed, as well as the presence of ossified fragments of the intervertebral disc at the Th12-L1 level, which caused absolute stenosis of the spinal canal. In the Romodanov Neurosurgery Institute of National Academy of Medical Sciences of Ukraine, revision surgery was performed: adequate repositioning of the stabilization system and extensive decompression of the spinal canal with facetectomy and complete decompression of the dural sac. During the follow-up examination after 4 months, regression of the neurological deficit from ASIA A to ASIA B was recorded.

In the article we analyze classic errors during surgery of traumatic injuries of the thoracolumbar junction and the expediency of performing decompressive-revision surgical interventions in the late period of spinal cord injury.