1.
Case presentation
Dr. Mohammad Delower Hossain
MS-Phase B Resident
Violet unit-1

2.
Particulars of the patient
 Name: Mr. Shahidul Islam
 Age: 38 years
 Address: Uzirpur, Barishal
 Registration no.: 257554/22
 Ward: New building
 Bed no.: G-864
 Date of admission: 03/12/2022
 Date of examination: 10/12/2022

3.
Presenting complaints
1) Pain in the low back region following fall of heavy
objects over his lower back 09 days back.
2) Inability to move both lower limbs for same duration.

4.
History of present illness
According to the statement of the patient he was
reasonably well 09 days back. Then suddenly he
experienced a severe trauma in his low back region
following fall of heavy objects over his lower back.
The patient complains of severe pain in his low back
region & inability to move both lower limbs following
the trauma. He also complains of difficulties in bowel
& bladder functions.

5.
History of present illness cont.
Initially he was taken to a nearby hospital &
treated in the form of analgesics & bed rest, but the
condition did not improve. With these complaints he
was admitted to NITOR for better management.

6.
History of past illness
 No significant past medical or surgical illness.
Family history
 Nothing significant.

7.
On examination
General examination
 Appearance: Ill-looking
 Body Built: Average
 Nutritional status: Average
 Anaemia: Absent
 Jaundice: Absent
 Cyanosis: Absent
 Pulse rate: 72/min
 Blood pressure: 130/80 mm of hg
 Respiratory rate: 15/min
 Temperature: 99°F

8.
On examination
Systemic examination
 All the systemic examinations reveal no abnormalities.

9.
On examination
Loco-regional
Look:
 Patient is bedridden in supine position with catheter
in situ.
 Overlying skin condition- Normal
 Swelling on midline in lower thoracic region.

10.
Feel:
 Local temperature: Normal.
 Tenderness: Present in lower thoracic region.
 Stepping: Present in lower thoracic region.
 Para-vertebral muscle spasm: Present.

11.
Move:
 Movements of spine was not elicited due to pain.

12.
Neurological examination
Sensory
Sensory
Level
Right Left
Absent Impaired Normal Absent Impaired Normal
S4-5 ✓ ✓
S1 ✓ ✓
L5 ✓ ✓
L4 ✓ ✓
L3 ✓ ✓
L2 ✓ ✓
L1 ✓ ✓
T12 ✓ ✓

13.
Neurological examination
Motor power: Lower limb
Level Key muscle MRC Muscle power
Right Left
L2 Hip flexor 0/5 0/5
L3 Knee extensor 0/5 0/5
L4 Ankle dorsiflexion 0/5 0/5
L5 Great toe extensor 0/5 0/5
S1 Ankle planter flexor 0/5 0/5

14.
Reflex
 Bulbocavernosus reflex: Present
 Anal wink: Present
 Knee jerk: Absent
 Ankle jerk: Absent

15.
Salient feature
Mr. Shahidul Islam, a 38 years old day labourer
from Uzirpur, Barishal presented with the complaints
of pain in the low back region following fall of
heavy objects over his lower back region 09 days
back. He also complains of inability to move both
lower limbs & difficulties in bowel & bladder
functions for the same duration. On general physical
examination the patient was found ill-looking,
bedridden in supine position & all other vitals were
found within normal limit.

16.
Systemic examination reveals normal
findings. On loco-regional examination- tenderness,
stepping & gibbus deformity present over lower
thoracic region. Sensory is absent over all the
dermatomes distal to T12, muscle power of lower
limb according to MRC grading is 0/5, knee &
ankle jerks are absent, bulbocavernosus reflex &
anal wink present.

17.
Imaging

18.
Imaging

19.
Imaging

20.
Imaging

21.
Imaging

22.
Diagnosis
09 days old post-traumatic fracture-dislocation of
D12 over L1 vertebra with complete spinal cord injury
(ASIA-A), AO type-C, TLICS score-8 in a 38 years old
male patient following fall of heavy objects over his
lower back.

23.
Unit plan
Correction of dislocation, stabilization by pedicle
screws & rods & postero-lateral fusion by autogenous
cancellous bone graft.

24.
Thank you