A case from Dr. Ali Baaj and spine fellow Dr. Ibrahim Hussain was recently featured in the Spine Universe Case Study library. The online library places spine cases from around the country in front of fellow spine surgeons for discussion and review.
The featured case focused on a 30-year-old man who had sustained L1 and L2 fractures during a helicopter crash abroad a year earlier. The patient came to Dr. Baaj with complaints of persistent, debilitating back pain that felt worse with each movement.
“Unfortunately, we didn’t have access to the patient’s original preoperative imaging,” says Dr. Baaj. “During our evaluation of the patient and his index procedure, we were curious if bracing alone would have been a better choice than creating a biomechanically unsound construct at the thoracolumbar junction. The patient’s mechanical back pain with the evidence of non-fusion were indications for revision surgery. The new rods that were implanted were contoured to more closely match the patient’s alignment in the thoracolumbar region.”
The outcome showed improvement in the patient’s spinal alignment. Dr. Baaj noted that the patient “remained neurologically intact with marked improvement in mechanical back over the initial month before returning to his home country.”
Dr. Baaj’s case was reviewed by Dr. Gerald Rodts, Jr., of Emory University School of Medicine, who agreed with Dr. Baaj’s decision. “Bracing (alone) was highly unlikely to provide any benefit,” Dr. Rodts wrote in his online comment. “The original construct for treating these two fractures was inadequate to prevent proximal failure and increased kyphosis.”