How can a 75-year-old woman heal from a C3 fracture?

Question

Hello doctor,

A 75-year-old woman was in a car accident that occurred ten days ago, resulting in her hospitalization. She has the following conditions:

Acute avulsion fracture of the antero-inferior aspect of the C3 vertebral body with an associated anterior longitudinal ligament tear.
Multifocal post-traumatic cord contusion superimposed on underlying compressive myelopathy.
Multilevel cervical disc-osteophyte complex with cord compression.

However, she does not have diabetes or heart problems and was in normal health prior to the accident. She was able to walk previously but now lacks sensation in her lower body. She can lift and move her hands slightly, but she cannot grasp objects. Currently, she is unable to urinate or defecate on her own.

May I know the best treatment options (surgical or physiotherapy) and how to care for her to help her regain the ability to walk? Her current medications are:

Normal saline drip (500 ml).
Proton-P 40 mg (injection).
Nucleo CMP Forte (injection).
Solu-PRED 500 mg (injection).
Amlong 5 mg.
Telsafe 40 mg.
Vitamin B Denk.
5 mL water for Injection.
Stripole 40 mg (Injection).
Orofer.
Lyrica 25 mg.
Onacine (500 mg/35 mg).

Kindly help.

Answer 1

Hello,

Welcome to icliniq.com.

I read your query and understood your concern.

It would have been helpful if you could share the MRI (magnetic resonance imaging) films. However, based on the report, I can assume that there is ongoing compression of the spinal cord, which is also reflected in her neurological examination. She has weakness in both the upper and lower limbs. In this condition, I recommend surgery, where the cord compression needs to be relieved and the bones should be fused using implants. However, my opinion may change based on the MRI films.

Now, regarding the second part of your question, whether she will be able to walk again, this is difficult to predict. Traumatic injuries, in general, are challenging to recover from. That being said, as you have mentioned, she does not have sensation in the lower body, which is a poor sign, and the chances of recovery are very low. However, we need to give it a try. Surgical decompression and fixation will allow us to mobilize her early and avoid other complications, such as respiratory infections or bed sores. It has already been a week since the injury, and the longer surgery is delayed, the graver her prognosis may become.

In the end, I would still say that my opinion about surgery may change after reviewing the MRI films. If you can share them, I will be in a better position to guide you regarding surgery.

I hope this has helped you.

Kindly follow up if you have more doubts.

Thank you.