Evaluation of the Results of Posterior Decompression, Corpectomy and Instrumentation in Traumatic Unstable Thoraco-Lumbar Burst Fractures

Background: Thoraco-lumbar burst fractures occur as a result of axial load which often causes displacement of the middle column into the vertebral canal. Posterior surgery reduces the morbid outcomes of different other approaches. Objective: To evaluate the clinical and radiological success of posterior corpectomy and instrumentation in the management of traumatic unstable thoraco-lumbar burst fractures. Methods: It is a prospective interventional study carried out in Bangabandhu Sheikh Mujib Medical University and different private hospitals in Dhaka from July 2008 to December 2011. Total 18 patients; 13 male and 05 female within an age range of 21-40 years were selected. Total 09 cases involved L1, 05 cases at D12, 02 cases at D11 and at L2 each. Neurological status was assessed by Frankels grading and pain status by Visual Analogue Score (VAS). Paired t-test was used for statistical analysis. Results: All the patients were followed up for minimum 1 year. Eleven out of 12 patients with Frankel grade-B and 04 patients out of 06 with Frankel grade-C recovered fully and could walk without support (p<0.05). Overall 03 patients ended with some degrees of persistant neurological deficit. The mean postoperative pain improvement and kyphotic angle correction was significant  (p<0.05). Conclusion: Decompression through posterior approach by laminectomy, corpectomy and fusion by cage with bone graft and stabilization by pedicle screw and rod significantly improves the clinical and radiological outcome in management of traumatic unstable thoraco-lumbar burst fractures.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.10998 BSMMU J 2012; 5(1):35-41

Treatment of Scoliosis by Hartshill Rectangle and Sublaminar Wiring

Background: Scoliosis is a complex three dimensional deformity characterized by coronal, sagittal and horizontal plane deviation. Treatment of scoliosis has made significant development in techniques and modalities of internal fixation. Objective: To see the efficacy of Hartshill rectangle and sublaminar wiring for correction of scoliotic deformity, clinical outcome and patients satisfaction. Methods: During the period of July 2008 to June 2011, 14 patients of scoliotic spinal deformities of various etiologies (Congenital-02, idiopathic-12) were operated. Age ranged from 11 to 23 years with mean 16.71 ± 03.22 years. Female 09 and male 05 patients were included where Hartshill rectangles with sublaminar wiring were used for every case. Results: At least 12 months (range 12-36 months) follow up regarding clinico-radiological evaluation and patients satisfaction were accounted as per the SRS-24 questionnaire. The mean scoliosis in the coronal plane (Cobbs angle) measured 53.50o ± 03.98o preoperatively reducing significantly to 21.14o ± 02.77o (p<0.05) and the mean preoperative sagittal plane angle 60.14o ± 07.30o reducing significantly to average 42.14o ± 05.28o (p<0.05) at 1 year as determined by paired t-test. No neurological complication was seen except transient hyperesthesia in 02 patients, superficial wound infection in 01 patient and 01 wire breakage. All the patients were happy to live with their present back status. Conclusion: Overall outcome in segmental spinal fixation with sublaminar wire and Hartshill rectangle is satisfactory and effective.DOI: http://dx.doi.org/10.3329/bsmmuj.v5i1.10981 BSMMU J 2012; 5(1):6-1

Management of traumatic spinal column injury: A tertiary hospital experience

Background: Trauma is the leading cause of disability in the first four decades of life and third most common cause of death. Spinal trauma poses considerable threats to survival and quality of life.Objective: Aims of this study is to assess the demographics, mode of trauma, hospital stay, complications, neurological improvement and mortality.Methods: Retrospective Cross sectional analysis of the records of spinal injury patients admitted in the Spine Unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital from October 2003 to December 2013 was carried out. The demo­graphics, mode of trauma, involved vertebral level, co-morbid factors; neurological status and its improvement by Ameri­can Spinal Injury Association (ASIA) Score, duration of hospital stay and complications during hospital stay was assessed. Results were analyzed by SPSS.Results: Out of 1288 patients admitted, 192(14.90%) patients(range, 8-72 years) sustained spinal injuries and most (63.02%)of them were young (range, 21-40 years). Male to female ratio was 5:1. Cervical spine was most commonly ( 44.66%) affected followed by lumbar (35 .41 % ), thoracic (13 .54% ), thoraco-lumbar (06.25%) and Cervico-thoracic (03.13%) region. Fracture through intervertebral disc was most common in cervical spine. Among the common causes were road traffic accidents (44.47%), fall from height (29.69%), heavy weight bearing (14.58%) and assault with gunshot (07.29%). Paraparesis was most frequent (51.05%) clinical presentation followed by quadriparesis (45.83%). Significant number of patients (83.33%) required operative treatment (p<0.05) and 09.89% were managed conservatively. Mortality rate (03.64%) was insignificant (p>0.05%) and 03.12% patient refused to take treatment. Of these patients, 77.01 % had shown neurological improvement of at least one grade according to ASIA Score.Conclusion: Wide varieties of patients are encountered and managed varying from conservative to surgery. Carefully selected treatment provides the utmost outcome and reduces mortality

Management of traumatic spinal column injury: A tertiary hospital experience

Background: Trauma is the leading cause of disability in the first four decades of life and third most common cause of death. Spinal trauma poses considerable threats to survival and quality of life.Objective: Aims of this study is to assess the demographics, mode of trauma, hospital stay, complications, neurological improvement and mortality.Methods: Retrospective Cross sectional analysis of the records of spinal injury patients admitted in the Spine Unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital from October 2003 to December 2013 was carried out. The demo­graphics, mode of trauma, involved vertebral level, co-morbid factors; neurological status and its improvement by Ameri­can Spinal Injury Association (ASIA) Score, duration of hospital stay and complications during hospital stay was assessed. Results were analyzed by SPSS.Results: Out of 1288 patients admitted, 192(14.90%) patients(range, 8-72 years) sustained spinal injuries and most (63.02%)of them were young (range, 21-40 years). Male to female ratio was 5:1. Cervical spine was most commonly ( 44.66%) affected followed by lumbar (35 .41 % ), thoracic (13 .54% ), thoraco-lumbar (06.25%) and Cervico-thoracic (03.13%) region. Fracture through intervertebral disc was most common in cervical spine. Among the common causes were road traffic accidents (44.47%), fall from height (29.69%), heavy weight bearing (14.58%) and assault with gunshot (07.29%). Paraparesis was most frequent (51.05%) clinical presentation followed by quadriparesis (45.83%). Significant number of patients (83.33%) required operative treatment (p<0.05) and 09.89% were managed conservatively. Mortality rate (03.64%) was insignificant (p>0.05%) and 03.12% patient refused to take treatment. Of these patients, 77.01 % had shown neurological improvement of at least one grade according to ASIA Score.Conclusion: Wide varieties of patients are encountered and managed varying from conservative to surgery. Carefully selected treatment provides the utmost outcome and reduces mortality

Management of traumatic spinal column injury: A tertiary hospital experience

Background: Trauma is the leading cause of disability in the first four decades of life and third most common cause of death. Spinal trauma poses considerable threats to survival and quality of life. Objective: Aims of this study is to assess the demographics, mode of trauma, hospital stay, complications, neurological improvement and mortality. Methods: Retrospective Cross sectional analysis of the records of spinal injury patients admitted in the Spine Unit of Bangabandhu Sheikh Mujib Medical University (BSMMU) Hospital from October 2003 to December 2013 was carried out. The demo­graphics, mode of trauma, involved vertebral level, co-morbid factors; neurological status and its improvement by Ameri­can Spinal Injury Association (ASIA) Score, duration of hospital stay and complications during hospital stay was assessed. Results were analyzed by SPSS. Results: Out of 1288 patients admitted, 192(14.90%) patients(range, 8-72 years) sustained spinal injuries and most (63.02%)of them were young (range, 21-40 years). Male to female ratio was 5:1. Cervical spine was most commonly ( 44.66%) affected followed by lumbar (35 .41 % ), thoracic (13 .54% ), thoraco-lumbar (06.25%) and Cervico-thoracic (03.13%) region. Fracture through intervertebral disc was most common in cervical spine. Among the common causes were road traffic accidents (44.47%), fall from height (29.69%), heavy weight bearing (14.58%) and assault with gunshot (07.29%). Paraparesis was most frequent (51.05%) clinical presentation followed by quadriparesis (45.83%). Significant number of patients (83.33%) required operative treatment (p0.05%) and 03.12% patient refused to take treatment. Of these patients, 77.01 % had shown neurological improvement of at least one grade according to ASIA Score. Conclusion: Wide varieties of patients are encountered and managed varying from conservative to surgery. Carefully selected treatment provides the utmost outcome and reduces mortality