Concluded Case

Gradually progressive Paraparesis

A young male aged 33 years who gives a history of traumatic injury (of fall from bike) Chief Complaints Gradually progressive Paraparesis over 2 months (Initially only numbness and now confined to wheelchair) Physical Examination B/l DTR exaggerated in lower limbs Plantar - no response Investigations MR Spine

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Concluded answer

Complete collapse compression of D6 vertebra with exteadural compression and swelling of spinal cord at D 5-6 level.Intervertebral space of D6-7 is narrowed.D3 vertbra also shows marrow edema with thecal compression at D3 level.D2 and D3 intervertebral space look narrowed. Exyeadural compressive myelopathy. Needs further investigations.DD Spinal TB/ myeloma.Suggest Consult to spinal surgeon / Neurosurgeon

All Answers

Complete collapse compression of D6 vertebra with exteadural compression and swelling of spinal cord at D 5-6 level.Intervertebral space of D6-7 is narrowed.D3 vertbra also shows marrow edema with thecal compression at D3 level.D2 and D3 intervertebral space look narrowed. Exyeadural compressive myelopathy. Needs further investigations.DD Spinal TB/ myeloma.Suggest Consult to spinal surgeon / Neurosurgeon

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Unusual fracture pattern for a traumatic injury in a 33yr old Progression also arouse suspicion, unusual in trauma Rule out TB spine which can produce collapse with minor trauma Need CT correlation CBC esr Mantaux test Chest xray Neurosurgery opinion regarding decompression and biopsy

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Dorsal vertebral #D6 predominantly compressing spinal cord D3to 5 are just looks to be ligamentum injuries Needs exploration and decompression with STEEL JACKET fixation Supportive treatment and physiotherapy Likely to recover in 6months period with active nursing care

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