December 11th, 2024 By: Amber S. Gordon, MD. Neurosurgeon
Our Patient
Our patient was diagnosed with an unstable lumbar burst fracture. This is when the vertebra shatters in multiple directions, often dispersing fragments into surrounding tissues or even the spinal cord. In our patient, this occurred due to the severe trauma she experienced after being ejected from the moving ATV. This trauma moved her vertebrae out of thier usual alignment.
Compression Fracture
A compression fracture happens when a patient falls and has an axial loading on thier spine. This causes the spine to buckle or fracture. She showed us a wedge fracture, which is when the fracture causes the spine to fold in a wedge-like shape. This fracture is stable and does not require surgery.
Burst Fracture
A burst fracture occurs when an axial load pushes a bone out of the spinal cord. This will push the bone into the nerves and disrupt the spinal cord and canal. This requires surgery since the fracture is unstable.
The OR
After leaving the emergency room our patient was taken to the OR. When a patient is taken to the OR, thier spinal cord injury is graded on the ASIA Grading. They test the patient's muscle strength, specifically muscles that are attached to nerves in the back. Our patient had no sensation below her belly button, which means she scaled an "A" on the ASIA scale. This means she needs an instrumental infusion and stabilization. This means she needs surgery!
During the surgery, the neurosurgeon will reduce the fracture and stabilize it with screws and rods. The rods and screws work as an internal cast, this allows the bones to heal quicker. When reducing the fracture, they will remove some of the bone and replace it with cement. Dr. Gordon allowed us to attempt putting a screw into a patient's spinal cord. Working with the spine and nerves is extremely stressful since there is little room for error. They use a multitude of different instruments specifically designed for spinal surgery. I got to practice using an Awl, Gear Swift, a Tap, Ball tip-probe, and surgical screws. This was so interesting to see while performing the surgery.
After the surgery, our patient recovered her sensation back in her legs and lower abdomen. She is going to be placed in a TLSO brace for a few weeks after the surgery. She is going to be restricted in her movement, with no BLT (bending, lifting, or twisting) or bearing any weight heavier than a jug of milk. These limitations will be in place for the next two to four weeks.
Dr. Gordon and NP Brooke
I thoroughly enjoyed this guest speaker. She is the only female neurosurgeon in Mobile, so I found it extremely inspiring to hear from her! She was an amazing speaker and was so fun to talk to! She attended Vanderbilt and UAB, which are two schools that I have been looking into, so that was interesting. I especially loved her pink scrubs. Her Nurse Practitioner, Brook, was also super sweet. These two have to be some of my favorite guest speakers I have gotten to listen to so far!
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