From “cage to independence”: good outcomes of an unstable (burst) lumbar fracture, surgically managed with an expandable titanium vertebral cage implant, with posterior transpedicular instrumentation, and rehabilitation program – case presentation

• Main Authors: ANGHELESCU Aurelian, CÎMPEANU Cristina, BĂJENARU Alina Oana, FRECEA Ionut Octavian, CHECIU Gheorghe, ONOSE Gelu
• Format: Article
• Language: English
• Published: Romanian Association of Balneology, Editura Balneara 2018-12-01
• Series: Balneo Research Journal
• Subjects: : lumbar burst fractures; paraplegia; vertebrectomy reconstruction; titanium expandable cage; rehabilitation; outcomes
• Online Access: http://bioclima.ro/Balneo213.pdf
• ISSN: 2069-7597; 2069-7619

Introduction: The thoracolumbar junction (T11-L2) is biomechanically prone to spinal cord injuries (SCI), as it marks the transition from the rigid thoracic segment to the flexible lumbar spine. The damage of the spinal cord is due to a high-energy trauma (mainly motor vehicle accidents, falls from height, etc), in most cases resulting burst fractures of the lumbar region. The vertebral body is crushed in all directions, retro pulsed bony fragments are spread out towards the spinal canal, damaging the spinal cord, and causing neurologic injuries. Case report: This is a retrospective case study of a slim 43-year-old woman who suffered on 23.06.2018 a polytrauma (accidental fall from 3m height, from tree), associating thoraco-abdominal contusions, without cranial trauma and a severe L1 vertebral comminuted / burst fracture, followed by flaccid T12 AIS-A (complete) paraplegia. She underwent a complex neurosurgical approach, with a self-expandable metallic cage (Stryker) and posterior transpedicular stabilization for decompression and circumferential fusion in one stage, without cavity involvement. In an early post-acute stage she was admitted to the Rehabilitation Clinic (from 10.07.2018 until 31.08.2018) as a T12 AIS-C paraplegia (incomplete neurological lesion, with a global motor score 59/100; lower legs motor score 9/50 [4/25 R+5/25 L], with neurogenic bowel and bladder. The evolution was favorable and she was discharged as L2 AIS-D paraplegia (global motor score 70/100; lower legs motor score 20/50 [10/25 R+10/25 L]. Discussion: This case report emphasizes the benefits and functional outcomes after a comprehensive therapeutic approach, of a patient with unstable (burst) lumbar fracture, surgically managed with an expandable titanium vertebral cage implant with posterior transpedicular instrumentation, followed by a complex rehabilitation program, Stryker distractible vertebral body replacement implant is an expandable device, which can adapt to the patient`s anatomy, enabling the neurosurgeons to treat severe burst fractures. Rehabilitation objectives were focused on B-ADL independence (activity, component of the ICF-DH framework) – transfers, orthostatic posture, restore walking, bladder control. The vital prognosis and functional outcome were favorable. Although she was able to use a walking frame at discharge, there were a few drawbacks in what concerns the professional reintegration, due to specific external barriers (she was a military personnel, had neither driving licensee, nor an adapted car). Conclusions: This clinical case underlines the importance of a complex and multidisciplinary approach, prompt surgical intervention and rehabilitation during the early post-acute phase.