Fig. 15.1 Unstable burst fracture with rotation of the third and fourth lumbar vertebral body after a high-speed injury (motor vehicle accident)
Fig. 15.2 Incomplete paralysis of both legs as a result of spinal cord and nerve impaction by bone fragments
Fig. 15.3 Result of an open adjustment/manipulation (reposition) of the fracture with removal of the bone fragments (decompression) and vertebral body replacement
Fig. 15.4 Stable healing 1 year after the accident. The screws and rods have already been removed.
The 19-year-old patient is injured in a severe car accident. The accident happened at a speed of more than 100 km/h, so that the impact has caused the unstable burst rotation fracture with rupture of the disc, vertebral joints and ligaments (Fig. 15.1).
Parts of the shattered third lumbar vertebral body were pushed backwards and narrowed the spinal canal by about 70%. As a result, the patient's legs are partially paralysed with the presence of numbness. There is great need for fast action. Initial x-rays and CT examinations aid in the immediate planning of the operation. The main aim is to rapidly decompress the nerve tissue in the vertebral canal, i.e. free the space surrounding the nerve tissue. For this purpose, the broken bone fragments must be removed from the region of the vertebral body (Fig. 15.2).
After these steps, the nerve tissue in the spinal canal has enough space, which allows adequate conditions for the recovery of neurological deficits. In this example, a vertebral body replacement implant (titanium cage) is also selected to promote stable bone healing (360° fusion) with as little correction loss as possible during the after-care period (Fig. 15.3).
Not all patients fully recover from incomplete paralysis after a distraction/rotation injury of the spinal column despite prompt treatment. Our patient could be transferred to a rehabilitation clinic a few days after the operation, where she recovers completely from the initial neurological deficits during the rehabilitation phase including muscle training and therapy. Screws and rods are removed one year later (Fig. 15.4).