Ben Birkenfeld, MD
Resident
Hackensack Meridian JFK Johnson Rehabilitation Institute
Edison, New Jersey, United States
Lei Lin, MD
Attending
Hackensack Meridian JFK Johnson Rehabilitation Institute
Edison, New Jersey, United States
A 25-year-old female with achondroplasia presented to acute inpatient rehabilitation after traumatic spinal cord injury (TSCI) from a motor vehicle collision. She presented with upper and lower extremity weakness and bowel/bladder dysfunction. Imaging of the cervical spine demonstrated multilevel cervical spondylosis with multilevel spinal cord impingent and osteophytes at C4-C5 with right-sided disk herniation causing spinal cord flattening. She received steroid treatment and underwent C4-C6 posterior cervical decompression and fusion. Upon admission, ISNCSCI examination yielded a neurological level of injury (NLI) of C2 and ASIA impairment scale (AIS) A. The patient underwent therapy focusing on trunk control, transfers, and use of standing frames. Six weeks later, repeat examination demonstrated recovery with NLI = C5, AIS C. Her functional independence was exemplified by her ability to use a power wheelchair, self-feed using adaptive devices, and communicate via cellphone. With family education, ramp installment, and bathroom modification, the patient will return home.
Discussions:
TSCI is a debilitating pathology with a range of functional outcomes. Repeat ISNCSCI examinations are used to classify neurological recovery, with a minority of patients improving from AIS A to AIS C. This patient was expected to have a poorer recovery due to pre-existing bone pathology associated with achondroplasia and complete TSCI. However, she made significant improvements within six weeks. Such improvement exemplifies the importance of aggressive inpatient therapy and demonstrates that pre-existing musculoskeletal conditions should not preclude patients from successful rehabilitation.
Conclusions:
Individuals with pre-existing musculoskeletal conditions may incorrectly be expected to make limited functional gains. Here, a patient with achondroplasia was able to make significant improvements, leading to increased independence with ADLs and discharge home.
