Emergency decompression and stabilization of 1(st) thoracic spinal cord injury and sacral fracture in a Covid-19 patient: A case report

INTRODUCTION AND IMPORTANCE: Spinal cord injury is mostly caused by traumatic accident and usually associated with several injuries. The ideal treatment of orthopaedic injury is to perform surgical decompression and stabilization early. CASE PRESENTATION: A 24-year-old-male patient came in emergency department with history of severe pain in his thoracic vertebrae after fell from 10 m height. His buttock was hit the ground first and patient was alert. He felt hypoesthesia below the injured level and dysfunctional motor and sensory of both lower extremities. We put pedicle screw at the C7, Th1, Th2 and Th 3. Then we put rods and nuts. After that, we did decompression by laminectomy of the C7 and Th1 and we put vacuumed drain for the wound. CLINICAL DISCUSSION: This patient was diagnosed with traumatic spinal cord injury of 1st thoracic vertebra ASIA Impairment Scale (AIS) C and sacral fracture Denis classification zone II of right side with confirmed Covid-19 case. First patient treated with 1000 mg methyl prednisolone. An early surgical treatment was open reduction and internal fixation (ORIF) sacral fracture. We put a two-hole 4.5 narrow dynamic compression plate (DCP) at the lateral side of posterior ridge of iliac bone, between posterior superior iliac spine (PSIS) and posterior inferior iliac spine (PIIS). CONCLUSION: Immediate surgical decompression and stabilization for spinal cord injury give significant improvement in motor and sensory function. Appropriate management for Covid-19 patient with Favipiravir and some supplements, had been proved control the virus and give patient good quality of life.