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Examination

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History

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The patient is a 21-year-old woman involved in a motor vehicle accident on January 4. She was a restrained passenger in a reclined position when the car hydroplaned head-on into a guard rail. The patient denied loss of consciousness (Glasgow Coma Scale = 15). She was taken to a local medical center, where she presented with immediate loss of movement and sensation in her lower extremities (LEs).

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Imaging revealed a burst fracture of the L1 vertebral body and lamina, an L2–3 right transverse process fracture, and bony fragments were noted to have extended into the spinal canal. There was a 40% lateral displacement of the spinal cord in relation to the vertebral bodies. In addition to the spinal cord injury (SCI), she sustained a right pneumothorax, right pulmonary contusion, and multiple rib fractures on the right. The methylprednisolone (a high-dose steroid aimed at reducing the swelling) protocol was initiated in the emergency room. A T11–L3 posterior spinal stabilization was performed on January 5. Postoperatively she remained paraplegic and had sensation to her abdominal area. A computed tomography (CT) scan of the head was negative. A prophylactic vena cava filter was placed during the surgery on January 5.

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  • Demographic Information:

    • Height: 5 ft, 5 in. (1.7 m)

    • Weight: 114 lb (52 kg); previously 125 lb (57 kg) at the time of her accident

  • Social History:

    Patient lives with her mother and grandmother. Her parents are divorced. She denies tobacco or alcohol use.

  • Employment:

    Patient is a full-time student at a local community college and is interested in obtaining her degree in early childhood education. She also worked part-time as a dance instructor at a local dance studio.

  • Living Environment:

    The family lives in a one-story rental home. There are two steps leading up to the front door. They do not have plans to move or the financial means to purchase a home at this time.

  • General Health Status:

    Prior to her injury, the patient was in very good health. She is an accomplished dancer, having won multiple state and national dance competitions. She had asthma as a child; however, she has had no difficulties with asthma in adulthood.

  • History of Present Illness:

    The patient was admitted to a SCI Model System of Care for rehabilitation on January 16. The initial examination indicated a T9 SCI with an American Spinal Injury Association (ASIA) Impairment Scale designation of A: complete injury (no motor or sensory function is preserved in the sacral segments S4 to S5).1 Initial radiological films revealed a stable T11 to L3 fusion (Fig. CS7.1). She arrived in a thoracolumbosacral orthosis (TLSO), which was replaced with a less-restrictive Jewett brace to decrease the risk of skin breakdown in areas of no sensation and to allow greater ease of forward flexion at the hips during transfers. The brace was discontinued on February 11. The admission motor and sensory screening examinations ...

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