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Abstract: The patient, a 31-year-old young woman, fell and injured her lumbar region, and presented with symptoms such as significant pain and inability to stand. The patient was finally diagnosed as “lumbar 1 vertebral burst fracture” by CT and MRI, and was immediately treated with posterior lumbar burst fracture with spinal canal decompression and internal fixation.
Basic information】Female, 31 years old
Disease Type】Lumbar 1 vertebral body burst fracture
Hospital】Shanxi Provincial People’s Hospital
Consultation time】August 2021
Treatment plan] Posterior lumbar burst fracture spinal canal reduction and internal fixation
【Treatment period】15 days of inpatient treatment, 1.5 months, 3 months, 6 months of outpatient follow-up
Treatment effect]: The vertebral body height was restored after surgery, and the symptoms were relieved, and the patient was discharged successfully.
I. Initial consultation
One afternoon in August 2021, patient Ms. Zhou was pushed into the emergency room by a flat cart, reporting back pain and inability to walk on the ground, and was recommended to be transferred to a higher level hospital after consultation at the local hospital. Examining the patient, pressing at the spinous process of lumbar 1 and 2 vertebrae, the patient had obvious pain and radiating pain in the left lower limb (a discharge-like pain transmitted from the proximal to the distal thigh after percussion of the lumbar vertebrae). The patient was instructed to move the limbs, which could move freely, with normal muscle strength and normal muscle tone, and no incontinence. When the patient came to the hospital, he brought his own CT and MRI scan of the lumbar spine, and the CT and MRI examination revealed a burst fracture of the lumbar 1 vertebral body, with the bone block protruding into the spinal canal and compressing the spinal cord. At this point, the patient was clearly diagnosed with a “lumbar 1 vertebral burst fracture”.
(Preoperative MRI film)
II. Treatment history
Before the patient came to the hospital, the local hospital doctors had informed the patient and his family of the seriousness of his condition. After hospitalization, we communicated with the patient and family and explained the condition: the patient had a burst fracture of the lumbar 1 vertebral body and the bone was protruding into the spinal canal, which was an indication for surgery and should be operated as soon as possible. The patient and family were initially hesitant, but after analyzing the advantages and disadvantages of surgery, the patient and family unanimously approved the surgery. After completing the relevant tests, a posterior lumbar burst fracture spinal canal reduction and internal fixation was performed on the third day of admission. After the operation, the patient’s signs were closely observed, and the positive and lateral lumbar spine radiographs were reviewed on the third day after the operation, and the patient wore a lumbar brace on the fourth day and was supported by his family to walk on the ground.
(Postoperative X-ray)
III. Treatment effect
The patient’s postoperative pain was relieved, and the angle of straight leg raising in bed was significantly increased compared with that before surgery. On the third postoperative day, the positive and lateral lumbar spine films were reviewed, and it was seen that the height of the lumbar 1 vertebral body with burst fracture was obviously restored, and most of the bone blocks protruding into the spinal canal posteriorly were also reset, and the compressed spinal cord was released, which was conducive to the recovery of nerves in the later stage. After reviewing the lumbar spine film, the patient wore a lumbar brace and gradually moved down to the ground with the support of his family. After 15 days of hospitalization, the wound gradually recovered and there was no sign of infection, and the patient was discharged from the hospital.
IV. Precautions
After the surgery, the patient’s lower limbs gradually returned to normal and the pain symptoms gradually decreased, so we are truly happy for the patient and his family. The patient was instructed to visit the clinic for review 1.5 months, 3 months and 6 months after discharge. In the first month after returning home, bed rest was the main focus, and the patient could move to the ground 3 times a day for no more than 5 minutes each time. If the patient’s back became uncomfortable during the movement to the ground, he should rest in bed in time; in the second and third months, the time for moving to the ground could be increased appropriately. During the period of bed rest, the limbs should be moved frequently, especially the flexion and extension of both lower limbs, to prevent thrombosis and bed rest complications, and the lumbar brace should be worn when moving to the ground.
V. Personal insight
When it comes to spine surgery, patients and their families are often resistant and reluctant to accept it at first, as is the case in this article. It makes sense that they would be reluctant to undergo the surgery, as it is costly and painful, and they would be concerned about the safety of the surgery. In general, however, spine surgery is often safe as long as the anesthesia and surgeon are skilled and there are no surprises. Surgery can restore the height of the vertebrae, relieve the bone mass from compressing the spinal cord, stabilize the spinal structure, and relieve the patient’s pain. As in this case, the patient was relieved of his troubles through timely surgical treatment.