Analysis of Outcome of Surgical Management of Thoracolumbar Fractures with Spinal Cord Injury

Thoracolumbar fractures with spinal cord rupture are devastating injuries occurring from motor vehicle accidents, fall from height and injuries related to occupation and recreational activities. It has major functional, medical, psychosocial and financial effects on the injured person, family and society. Recent trends towards open reduction, arthrodesis, and stable internal fixation of spinal fractures are to allow rapid mobilization of patients, reduced reliance on orthotic containment and protection against spinal malalignment or neurological injury when the patient was ambulant and to decrease the complications of prolonged bed rest. The aim was to analyze the functional outcome and neurological recovery following surgical management of thoracolumbar fractures with spinal cord injury. The objective was to analyze the influence of timing of surgery in the chance of neural recovery in traumatic spinal cord rupture. A Prospective descriptive studywas carried out from June 2008 to June 2010 in patients with post traumatic thoracolumbar fractures with spinal cord injury in Government Coimbatore Medical College and Hospital, Coimbatore. Total of 25 patients [20 males and 5 females] with a mean age of 34.7, were operated and followed for a period of 6 months to 24 months. The commonest type of fracture was Burst fracture (64%). Five patients (20%) had Fracture dislocation and four (16%) had Compression fracture. Post-operatively, the patients were followed in the first, third, sixth, twelfth and eighteen month with clinical and radiological examination. Frankel’s grade improved to Grade E in five patients (20%) and Grade D in twelve patients (44%), six months after surgery. The neurological status remained static in six patients (Grade A 3 patients and Grade B – 3 patients). No intra-operative complications were observed. Post-operatively, six (24%) had sacral bed sores, four (16%) had respiratory infection and three (12%) had surgical site wound infection. All the six cases of sacral bed sores healed well after flap cover. Respiratory and wound infections settled with appropriate antibiotics. Severity of primary cord damage at the time of accident constitutes major factor in the neurological recovery of the patients. Earlier the intervention and less number of transfers of patients from place to place (less secondary neurological damage) gives good prognosis.