ABSTRACT
BACKGROUND: Cervical fractures are potentially serious and can have fatal consequences if not treated properly. Correct diagnosis and classification of injury is the first step in determining the most appropriate treatment. Cervical fractures will have an impact on the patient's work, and COVID-19 is a challenge in the hospital to treat a cervical fracture. This study aims to discuss the case of patients with cervical fractures that have undergone surgical treatment in the COVID-19 pandemic. CASE PRESENTATION: Two cases of emergency patients with cervical injury treated at the hospital in the acute setting of the COVID-19 pandemic. All these patients experienced delayed timing to arrive in the emergency department of Prof. Dr. R. Soeharso Orthopedic Hospital. Neurological outcome was assessed before being discharged after surgery and a 3-month follow-up post-surgery. RESULTS: Laminectomy and posterior stabilization and fusion (PSF) were performed immediately after diagnosis was established in both patients. Physical rehabilitation was performed. In a 3-month follow-up, both patients' neurological functions improved. CONCLUSION: Clinical outcomes of cervical injury patients can be affected by some factors, for example, timing to diagnosis, timing to traction application, timing to surgery, and timing to rehabilitation. Depending on the institution, weekend days can also affect the delay of the COVID-19 PCR swab. MRI schedule and patient optimal condition can also affect the timing to surgery. The immediate diagnosis and prompt treatment are needed to make a better outcome, especially better neurological status.
ABSTRACT
BACKGROUND: Previous studies have indicated that correction of an established kyphosis in spine tuberculosis is both difficult and hazardous. There has not been any publication about evaluation of surgical correction of spine tuberculosis in Indonesia, despite of high incidence of spine tuberculosis cases. Therefore, we evaluated the outcome of kyphotic angle correction and neurological status after surgery of spinal tuberculosis patients for better understanding. METHODS: Retrospectively, 96 patients with spinal tuberculosis that underwent operation in Soeharso Orthopedic Hospital from June 2016 to July 2019 were selected. Operation procedure includes laminectomy, debridement and posterior stabilization. We obtained plain x-ray of spine to evaluate the kyphotic deformity before and after surgery. We also examined neurological status of the patient before and after surgery. RESULTS: The average pretreatment kyphotic angle in thoracic tuberculosis was 33.69° (range 8°-86°), which improved into a significant change to 13.27° (range 0°-56°). Correction angle was <25° in 34 people, 25°-50° in 17 people, and >50° in 4 people. While in the lumbar tuberculosis, it was 25.52° (range 6°-80°), and improved into 11.51° (range 2°-48°). Correction angle was <25° in 35 people, 25°-50° in 4 people, and >50° in 2 people. Improved neurological deficit was shown in 12% of patient with lumbar tuberculosis, and the rest had constant neurological deficit. While in thoracic tuberculosis found that 7% have improved neurological deficit and the rest is constant. None of them have worsen neurological status after the surgery. CONCLUSIONS: Surgical treatment for kyphotic deformity in patient with thoracolumbar tuberculosis are effective and safe, even in high corrective angle (>50°).
