Now lets look at a case of a 33-year-old man who had Lumbar canal decompression + instrumentation done following Road Traffic Accident
A brief rundown on what actually happened:
He was involved in a Road Traffic Accident (RTA) where he was knocked down by a moving vehicle while he was standing beside his own car.
He fell down after the hit and felt a sharp pain in his back with associated inability to move his two Lowerlimbs. There was no trauma to the head, Loss of consciousness or bleeding from craniofacial orifices. However, he sustained bruises in different part of his body and there is an history of urinary incontinence.
Following the incident, he was immediately taken to a Hospital where he a had suture done for the wound he sustained in his left knee.
Radiological investigation (MRI) carried out revealed a Listhesis of Lumbar vertebrae 2 on 3 and ??Burst fracture of L1. He later underwent surgery- Lumbar canal decompression+ instrumentation. He has been stated to need physiotherapy
His past medical history stated that:
He is not hypertensive
He is not diabetic
He is not sickle-celled
He is not asthmatic or epileptic however he has an history of peptic ulcer disease
Past surgrical history:
He hasnt undergone any surgery before this incident
Surgical history:
He had Lumber canal decompression + instrumentation.
Drug History:
Warfarin, Naproxen, Metronidazole, Vitamin C, and Rocephin.
Family and social history: He works at a bar. He is single. He neither drink alcohol nor smoke cigarette.
On observation and examination:
A young male adult, met in a supine lying position in bed, fully conscious, alert, and oriented in Time Place, and Person. He is afebrile, acyanosed, anicteric, and not in any obvious respiratory or painful distress.
Urinary catheter in situ and Intravenous line was in place on the dorsum of the Left hand.
Vital Signs:
Blood pressure- 115/82mmHg
Pulse Rate- 86bpm
Respiratory Rate- 21cpm
PCV: 35%
SEGMENTAL EXAMINATION:
Head and Neck
No Abnormality detected
Active Range of motion & Passive range of motion are full and pain-free in all planes of movement
Thorax and abdomen:
Good chest excursion
The abdomen was normal, full, and Moved with respiration
Back:
Upper Limbs:
Lower Limbs: o
,-A clean and dry wound dressing around the Rt medial malleolus
Functional assessment:
Functional Independence Measure Score:
-Motor sub-score: 26/91
-Cognitive sub-score: 35/35
Total Functional independent measure score: 61/126
Radiological Findings
MRI revealed an Anterolisthesis of Lumbar vertebrae 2 on 3 (more than 25%). Post-surgical investigation is yet to be done.
Analysis of findings:
Clinical impression: Paraplegia 2⁰ to incomplete Spinal cord injury (ASIA C) following Road traffic accident
Plan of treatment:
Means of treatment
https://emedicine.medscape.com/article/793582-overview
https://www.physio-pedia.com/Spinal_Cord_Injury
https://www.ninds.nih.gov/health-information/disorders/spinal-cord-injury
