Dr Damian Muñoz

Dr Damian Muñoz
Curso mínima invasiva south beach

sábado, 22 de marzo de 2014

Discusión entre pares / 39 yr male...h/o trauma 6 mths back...gradual onset quadriparesis...

Abhishek Ray ha añadido fotos al álbum "March 17, 2014".
39 yr male...h/o trauma 6 mths back...gradual onset quadriparesis...bowel/bladder involved..ASIA C...evidence of cervical myelopathy..kindly give inputs regarding options and PEARLS of treatment...

  • Vedant Vaksha Neglected Fracture sublux C3-4 & C6-7 - C6-7 seems to be the culprit for myelopathy. The involved segements must have fused by know (Midline Sag CT Scan cuts). If C3-4 is not stenotic then Lami C5-6 or may be a level more & PSF in situ C3-T1/T2 seems a good option.
  • Sandeep Sonone Its unifacetal subluxation at c3-c4 and maybe unifacetal at c6-7 ..
    I would open up post ...do sup facet resection on subluxated side at both levels . Attempting reduction from post is out of question .
    Second stage anteriorly do a C34 dissectomy and fusion and C67 dissectomy and fusion and plating .
    This is young patient ..unifacetal pathology ...6 months old ...no point in fusing half or more of cervical spine at 40 .
  • DrSuresh Parmar I will go thr antrior...c3/4 n c6/7 dissectomy n fusion....plattng in c67
  • Vedant Vaksha Sandeep SononeDrSuresh Parmar - Do u not expect a fusion to have happened by now? Abhishek Ray - Could u please post midsag CT cuts to loo fofr fusion.
  • DrSuresh Parmar Yes it is thr bt ..v hv to reduc n fix in proor position
  • Niranjan Kavadi Abhishek Ray Can you post axial cuts at both levels? I feel C6-7 is bilateral so would resect bilateral facets at C6-7 and add a C6 laminectomy. Flip and then C6-7 and C3-4 ACDF. Would be interesting to see how much reduction is possible by taking down facets after 6 months.
  • Abhishek Ray I do not have the axial cuts with me here...but as u can see in the CT sag cuts,,,C3-4 is unilateral and C6-7 is b/l facet dislocn
  • Abhishek Ray The facets r not only dislocated but at both levels there r fracture-dislocations...with this in mind, is it biomechanically safe to do just C3-4 and C6-7 ACDF after facet excision posteriorly or does the situation warrant some sort of posterior fixn also...if so, how about doing just a C3-4 and C6-7 posterior fusion together with the same level ACDF...I agree that the xray is going to b really funny!!!...thots?
  • Niranjan Kavadi I meant axial cuts for assessing canal diameter and cord compression at both levels. C6-7 is obvious here but not sure how significant C3-4 is. If C3-4 is not compressive can we just aim at fusing c3-4 without any bony resection? Bimechanically not ideal but results with fusion for missed unreduced unifacetal dislocations have been shown similar once they fuse.
  • Abhishek Ray I am planning to take a chance at that...but thanks...will check the axial cuts once more..
  • Vedant Vaksha Good luck. do post the result & follow up.
  • Senthil T. Nathan the dislocation/usubluxation is 6 months old, most often they are fused . The idea of only doing acdf in both levels- it may be difficult to reduce it except if you doa corpectomy, also tye disc does not appear to be an offending agent in the front. I would just do a posterior laminectomy of c4 , lat mass/ped screws at c3-4,post laminectomy c7,post fusion of c6/t2
  • Senthil T. Nathan I had a similar case where i just did acdf and failed miserably especially when i did it in two. Different level sub/ dislocation
  • Senthil T. Nathan Guys also i have a suggestion why dont we convert this site on facebook into a gmail site like the indortho site due to various medicolegal issues
  • Senthil T. Nathan like a indian spine group website
  • Senthil T. Nathan this discussion can give some crazy people if one procedure is performed and some says another, in case it fails, this thread can be used against us, i am always sceptical to comment on treatment options
  • Abhishek Ray Though the medico-legal aspects are expected but still oblivious of it...but the idea is impressive
  • Senthil T. Nathan Wow , i will work on it and will be happy if any one of you can also help me . I will send an invite within a couple if weeks to you all
  • Abhishek Ray On a lighter note, please feel free to comment atleast in my patients...the merits of discussion far outweighs the demerits of a remotely possible scenario!!!BTW, thot that the moderators did have a discussion about this sometime back and the solution was to make it into a closed group...not fool-proof but may b a little more secure
  • Niranjan Kavadi Senthil T. Nathan Like the idea. Would make it a lot safer to share the information. Let me know if I can help.
  • Sandeep Sonone Like Niranjan Kavadi thought of fusing c3/4 without reducing but contact area fr fusion wud be less ..marginally though 
    Dont feel the bodies will fuse in 6 months time ..safer option would be to do a bck front . Reduction wont be achieved by facet excusion but by anterior disc realease and restoration of disc height ..
  • Gaurav Jain it would be better to do laminectomy c3 to 7 and lat mass fixation along with ACDF at c6/7 .... in a staged manner

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