38-year-old man was injured in a road accident and sustained severe cervical spine injury including vertebral fractures, for which he underwent posterior cervical spine fusion. The expert recommends intense rehabilitation.
1) What are the suggested therapies?
2) Are there any recommended centers in Italy or abroad?
3) What is the prognosis?
Medical Diagnosis: POST-TRAUMATIC C7 ASIA B TETRAPLEGIA
A 38 year old male had a road accident while driving a motorcycle. The patient was transported by helicopter to the Emergency Medical Service and arrived at the Vertebral Surgery Unit with complete paraplegia at T-3 level, priapism, and no anal reflex. Subsequently he developed a sensory deficit in the upper limbs and trunk. An MRI was performed (incomplete view of medulla due to an interference of the spinal board) and x-ray of the spinal column, which showed a dislocation-fracture at C7-T1. The patient underwent emergency surgery for a posterior reduction and stabilization at C7-T2 with Summit titanium bars and screws.
The patient was transferred to the Unipolar Spinal Unit where, on admission, he showed a C7 Asia A tetraplegia; he was carrying a permanent bladder catheter and was totally dependent in ADLs.
A rehabilitation plan was developed with intent to achieve the maximum autonomy possible.
After about 1 month from the traumatic event, the patient's diagnosis changed to a C7 Asia B tetraplegia; the neurological pattern is basically the same (found only a mild sign of voluntary adduction in inferior left limb and initial hypertone in lower limbs); neurological problems associated with bladder and intestine are unchanged, 4 catheterizations a day of normal volume and manual evacuation of stool in bed after microclyster or colon massage, skin is intact. He pushes himself in the wheelchair for short distances, and is able to make postural wheelchair-bed transfer with the board and minimal help.
Cervicodorsal MRI showed a hyperintense area at T2, partially extensive at the C7-T1 passage with corresponding hypointense signal on T-1, and surrounded by peripheral gliosis. Pattern suggests post-traumatic cyst. The discs between C3 and C7 show posterior protrusions, which mark the premedullary subarachnoid spaces and the ventral profile of the medulla at C5-C6 level.
A neurophysiologic exam with somatic-sensory evoked potentials produced by a stimulus in the lower limbs did not show cortical bilaterally evoked potentials.
We examined the x-ray and MRI of the patient's cervical spine. These revealed severe spinal chord damage and severe malacia between C7 and T1 with spinal fusion instrumentation in place. The patient's condition is severe, with complete quadriplegia. The only treatment we can recommend which is suitable to his condition at this time is intensive rehabilitation.