Acute traumatic spinal cord injury. Presentation of a series of clinical cases and their surgical approach

Abstract

Introduction: The traumatic spinal cord injury (TML) is the most frequent cause of spinal cord injury; its prevalence is 1:1000 people and its incidence ranges from 4 to 9 cases per 100000 people. It is produced by an external impact that generates injury to the spinal cord that leads to dysfunction, neurological disability and in some cases permanent damage. Objective: To present a series of clinical cases of acute spinal cord injury, evaluate the usefulness of surgical management and report the results obtained. Materials and methods: a retrospective descriptive study was performed, presenting clinical cases, for which authorization was requested from the teaching and research department of the hospital, for review of clinical records, publication of images and data. Results: Case 1: 35-year-old female, suffered gunshot wound in the thoracic region that caused complete injury and displacement of the fourth dorsal vertebra with deviation to the spinal canal. Surgery performed: transpedicular vertebral fixation with screw placement above and below the injury level. Postoperative result: patient after spinal trauma was left with neurological sequelae that persist to this day with mild motor recovery. Case 2: 18-year-old male with secondary acute spinal cord injury, gunshot wound at the level of second vertebral lumbar, reaches the emergency area without neurological deficit, mobilizes 4 limbs with 5/5 muscle strength without sensory deficit, pain located in the lower back. Surgery performed: laminectomy at the level of second lumbar and removal of projectile. Postoperative result: favorable evolution without neurological complications and without motor deficit. Case 3: A 60-year-old male who falls with cervical spinal trauma due to hyperextension of the neck, causing a low cervical spine injury with anterior displacement of the vertebral body of sixth and seventh cervical with instability. surgery performed: sixth and seventh cervical disc removal, plus box placement and anterior cervical plate for spinal stabilization. Postoperative result: favorable evolution with complete recovery at 5/5. Case 4: 35-year-old male presents cervical spinal trauma due to fracture in the body of fifth cervical, after launch in the pool and direct blow at the level of chin, with trauma in the cervical spine. Clinically characterized by 3/5 weakness in the right upper limb. Surgery performed: corpectomy at the fifth cervical level and placement of expandable mesh with anterior cervical plaque. In the second stage, fixing was performed with 6 screws at the level of fourth, fifth and sixth cervical vertebrae plus placement of 2 bars. Postoperative result: patient recovers upper right limb strength, progresses satisfactorily without neurological deficit. Conclusions: Spinal cord trauma is a condition that requires timely intervention, which is directly proportional to the results. In the four cases presented, various surgical techniques were used that were applied according to the level and type of spinal cord injury, because various traumatic forms of injury were manifested with individual surgical approach, obtaining favorable results, together with complementary treatment and physical rehabilitation