V-1 #dislocation D12 over L1 Dr Delower Hossain.pptx

Presentation

1. Case presentation Dr. Mohammad Delower Hossain MS-Phase B Resident Violet unit-1

2. Particulars of the patient Name: Mr. Shahidul Islam Age: 38 years Address: Uzirpur, Barishal Registration no.: 257554/22 Ward: New building Bed no.: G-864 Date of admission: 03 /12/2022 Date of examination : 10 /12/2022

3. Presenting complaints Pain in the low back region following fall of heavy objects over his lower back 09 days back. Inability to move both lower limbs for same duration.

4. History of present illness According to the statement of the patient he was reasonably well 09 days back. Then suddenly he experienced a severe trauma in his low back region following fall of heavy objects over his lower back. The patient complains of severe pain in his low back region & inability to move both lower limbs following the trauma . He also complains of difficulties in bowel & bladder functions.

5. History of present illness cont. Initially he was taken to a nearby hospital & treated in the form of analgesics & bed rest, but the condition did not improve . With these complaints he was admitted to NITOR for better management.

6. History of past illness No significant past medical or surgical illness. Family history Nothing significant.

7. On examination General examination Appearance: Ill-looking Body Built: Average Nutritional status: Average Anaemia: Absent Jaundice: Absent Cyanosis: Absent Pulse rate: 72/min Blood pressure: 130/80 mm of hg Respiratory rate: 15/min Temperature: 99°F

8. On examination Systemic examination All the systemic examinations reveal no abnormalities.

9. On examination Loco-regional Look: Patient is bedridden in supine position with catheter in situ. Overlying skin condition- Normal Swelling on midline in lower thoracic region.

10. Feel: Local temperature: Normal. Tenderness: Present in lower thoracic region. Stepping: Present in lower thoracic region. Para-vertebral muscle spasm: Present.

11. Move: Movements of spine was not elicited due to pain.

12. Neurological examination Sensory Sensory Level Right Left Absent Impaired Normal Absent Impaired Normal S4-5 ✓ ✓ S1 ✓ ✓ L5 ✓ ✓ L4 ✓ ✓ L3 ✓ ✓ L2 ✓ ✓ L1 ✓ ✓ T12 ✓ ✓

13. Neurological examination Motor power: Lower limb Level Key muscle MRC Muscle power Right Left L2 Hip flexor 0/5 0/5 L3 Knee extensor 0/5 0/5 L4 Ankle dorsiflexion 0/5 0/5 L5 Great toe extensor 0/5 0/5 S1 Ankle planter flexor 0/5 0/5

14. Reflex Bulbocavernosus reflex: Present Anal wink: Present Knee jerk: Absent Ankle jerk: Absent

15. Salient feature Mr. Shahidul Islam , a 38 years old day labourer from Uzirpur, Barishal presented with the complaints of pain in the low back region following fall of heavy objects over his lower back region 09 days back. He also complains of i nability to move both lower limbs & difficulties in bowel & bladder functions for the same duration. On general physical examination the patient was found ill-looking, bedridden in supine position & all other vitals were found within normal limit.

16. Systemic examination reveals normal findings. On loco-regional examination- tenderness, stepping & gibbus deformity present over lower thoracic region. Sensory is absent over all the dermatomes distal to T12, muscle power of lower limb according to MRC grading is 0/5, knee & ankle jerks are absent, bulbocavernosus reflex & anal wink present.

17. Imaging

18. Imaging

19. Imaging

20. Imaging

21. Imaging

22. Diagnosis 09 days old post-traumatic fracture-dislocation of D12 over L1 vertebra with complete spinal cord injury (ASIA-A), AO type-C, TLICS score-8 in a 38 years old male patient following fall of heavy objects over his lower back.

23. Unit plan Correction of dislocation, stabilization by pedicle screws & rods & postero-lateral fusion by autogenous cancellous bone graft.

24. Thank you