Purpose
A surgical treatment has been preferred in patients with unstable lumbar spine fracture-dislocation with incomplete paraplegia as it does not cause further nerve injury by regenerating and maintaining the shape of the spinal canal via the accurate reduction of fracture, and prevents additional complications by preventing neurovascular injury that secondarily occurs.1) However, the surgical treatment may be delayed or even impossible in patients with hemodynamic unstable state caused by an emergent concurrent injury. Accordingly, Stage operation was conducted on patients with unstable lumbar spine fracture-dislocation with incomplete paraplegia who had a difficulty in undergo immediate reduction and decompression due to hemodynamic unstable state caused by other concurrent injuries.
Methods
Postural reduction and minimal invasive percutaneous pedicle screw fixation L1-4 were conducted as a first stage operation, and L2-3 partial laminectomy, discectomy, and posterior fusion were then conducted as a second stage operation by applying the concept of stage operation in the department of spinal surgery.
Results
The first stage operation had a blood loss of 150cc and an operation time of 58 min. Compared to motor grade 3 shown in preoperative status, motor grade 4 was shown in L3 level or lower in a postoperative physical examination. The second stage operation was conducted two weeks later. It had an operation time of 90 min and a blood loss of 500cc. no neurologic change was further found.
Conclusion
Stage operation was conducted on patients with hemodynamic unstable state. Postural reduction and minimal invasive percutaneous pedicle screw fixation were conducted as a first stage operation to achieve the immediate reduction and stability of fracture and dislocation and the improvement of neurologic deficits.
Subsequently, decompression or fusion was conducted as a second stage operation under stable systemic status for through and accurate operation.
