Successful Treatment with Long-Segmental Transpedicular Screws for a Psychiatric Patient with Lumbar Spinal Fracture Dislocation

Kuang-Chen Hung ； Chung-Ching Hsia ； Yung-Hsiao Chiang ； Shinn-Zong Lin

《Journal of Medical Sciences》 22卷5期 (2002/10) Pp. 235-238

並列摘要

In the management of one-level thoracolumbar fracture, we usually perform surgical fixation with short-segmental transpedicular screws. However, for post-operative care of psychiatric patients, patient's restlessness should be considered. We present a 26-year-old single female, who had history of bipolar disorder, followed by a suicide attempt jumping from the 5^(th) floor. A neurological examination revealed acute cauda equina syndrome, and the neurological status was categorized as Frankel B. The lumbar spine X-ray revealed a burst fracture of L2 with fracture-dislocation and kyphotic deformity. The L2 vertebral body was collapsed to less than 30 % of normal height. Computed tomography demonstrated burst fracture of the 2^(nd) lumbar with severe compression of the thecal cavity. She received operation with long-segmental transpedicular screws (two above and two below the fracture site) on an emergency basis. The finding of the post-operative X-film showed good reduction, L2 vertebral body restoration and nearly normal lordotic curvature of lumbar spine. After having received a course of physical therapy at our rehabilitation division for 6 weeks, her neurological status recovered to Frankel B. She was then transferred to a psychiatric ward for further treatment after receiving a one-month course of the rehabilitation program. Six months after surgery, her neurological status had improved to the level of Frankel E without neurogenic bladder. The finding of her L-spine X-ray examination showed excellent restoration of L2 vertebral body height, improved lordotic curve, and successful fusion of the lumbar spine.

並列關鍵字

cauda equina syndrome ； fracture-dislocation ； lumbar spine ； psychiatric ； suicide