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The
patient came from Yemen to the clinic
19-June-2011
complaining of agonizing LBP with bilateral
sciatica for 2 months after falling down with
inability to walk or set. |
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MRI lumbar
spine done 14-May-2011 showing fracture L2 with
collection of the left iliopsoas muscle. MRI
repeated 04-June-2011 showing the same picture. |
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On
examination: the patient is walking with
the help of two persons. It was impossible to
evaluate the scoliotic stance. She was crying
during examination due to pain in the lower
back. SLRS was 25
degrees in the right side and 30 degrees in the
left. There is weak
dorsiflexion right foot -4/5. |
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CT-scan of
L1-L3 performed 20-June-2011 showing burst
fracture of L2 with bony compression in the
lumbar canal. |
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Septic
workup was performed and the WBC was 18.000, ESR
24 and CRP was 40. The CXS for Bac-tec was
negative for 6 days. The patient had no fever,
but was empirically covered with Avoxin 750 mg
and Zinnat 500 twice daily. She was
held in antibiotics for 2 weeks. |
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MRI lumbar
spine was repeated 03-July-2011 and the data
were the same as before. The WBC became 11.000,
CRP 24 and ESR became 40 mm/h.
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Skeletonization of L1-2-3
with preservation of the intraspinous ligament.
Zimmer Java monoaxial pedicle screw 45x6.5
mm was inserted from the right and 40x6.5 mm
from the left of L1 vertebra. Two monoaxial
40x6.5 mm transpedicular screws were inserted to
L3 body. Using left transpedicular approach, the
body of L2 was inspected and fragments were sent
for another CXS and tbc studies. There was no
pus, nor active inflammatory process in the
area. The empty cavity of L2 was impacted with
Novabone 5 cc. Using 90 mm length rods fixation
with reduction after distraction was applied to
the area. Transverse connector was applied. The
patient was covered with Targocid. |
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Routine
closure of the wound. All the stages of
surgery were performed with image-intensifier. |
