Outcome of Single-Level Surgical Fixation in Thoracolumbar Trauma with Complete Spinal Cord Injury
Keywords:
Thoracolumbar trauma, complete spinal cord injury, ASIA grade-A, posterior fixation, neurological outcomeAbstract
Introduction: Thoracolumbar trauma with complete spinal cord injury (SCI) is a devastating condition predominantly affecting young adults, resulting in permanent disability and significant socioeconomic burden. Surgical stabilization aims to restore spinal stability, enable early rehabilitation, and potentiate neurological recovery. The aim of the study was to evaluate functional, neurological, and radiological outcomes of single-level posterior surgical fixation in Thoracolumbar Trauma with complete SCI.
Methods: This quasi-experimental study was conducted at NITOR, Dhaka, from March 2021 to August 2023. Thirty-three consecutive patients aged 18-60 years with thoracolumbar (T10-L2) trauma, complete SCI (ASIA grade-A), single vertebra involvement, and TLICS score e”5 who underwent surgery within 14 days of injury were enrolled. All patients underwent posterior decompression, pedicle screw fixation, and posterolateral fusion. Outcomes were assessed at 12 months postoperatively using VAS, FIM motor score, ASIA scale, Cobb’s angle, Bridwell fusion grade, and complications.
Results: Mean age was 34.03 ± 9.235 years with 84.8% male predominance. Fall from height (84.8%) was the predominant cause. D12 (54.5%) and L1 (36.4%) were most commonly fractured. Mean time to surgery was 10.55 ± 2.56 days. Significant improvements occurred in VAS score (7 to 1, p < 0.001), FIM motor score (50.39 to 94.18, p < 0.001), and Cobb’s angle (30.58° to 5.61°, p < 0.001). Neurological improvement to ASIA-B occurred in only 3 patients (9.1%); 90.9% remained ASIA-A. No patient recovered bladder or bowel function. Bridwell fusion showed grade II (63.6%) and grade III (36.4%) with no nonunions. Complications occurred in 15.15% (UTI 9.09%, surgical site infection 3.03%, pressure sore 3.03%).
Conclusion: Single-level posterior fixation provides significant pain relief, functional improvement, kyphotic correction, and solid fusion with low complications. Although neurological recovery remains limited (9.1%) with delayed surgery, functional gains justify intervention. Early surgery within 24 hours is recommended to optimize neurological outcomes.
Journal of Surgical Sciences 2025;29(1): 43-49
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