No difference in cystometric capacity and intravesical leak point pressure at terminal detrusor overactivity was shown between complete and incomplete spinal cord injury patients in our survey, that is, represented findings are equally unfavorable for both groups. Incomplete SCI patients with NDO should be tested with cystometry and observed with same caution as we proceed in complete SCI patients.

Study design: Case report. Objectives: To report a rare case of hemodialysis-associated amyloidosis of cervical spinal canal with incomplete tetraplegia in long-term hemodialysis patient. Settings: Traumatology Clinic, Zagreb; Spinal Unit, Varazdinske Toplice, Croatia. Methods: Forty-seven-year-old male patient at long-term hemodialysis treatment developed progressive limbs weakness, graded as C4 ASIA C. Cervical computed tomography myelography showed extreme narrowing of the spinal canal. Decompressive laminectomy with bilateral foraminotomies was performed and histological examination revealed amyloidal deposition. Results: Rehabilitation program started immediately after surgery with physical and occupational therapy, along with psychological support aiming at restoring full activities of daily living. Three months after surgery, the patient returned to his community, neurologically improved to ASIA E. Hemodialysis program was regularly maintained perioperatively and during the rehabilitation. Conclusion: Vertebral involvement with neurological deterioration in hemodialysis-associated amyloidosis patients prompts for early diagnosis, surgical and rehabilitation management, in this instance with good outcome.

Introduction The case report evaluates the clinical and radiological success of early reposition, posterior decompression, posterolateral fusion and stabilization by titanium pedicle screws and rods, performed within six hours after injury in young patient with C-type second lumbar vertebrae (L2) fracture. Material and Methods 22 years old male patient presented in our Clinic with C-type L2 fracture after accident on work site when a part of truck engine felt on his back. The severity of injury was determined using the ASIA (American Spinal Injury Association) scale. Preoperative ASIA impairment scale was evaluated as grade C, with L2 as the most caudal segment with normal motor function. ASIA muscle grading was grade ⅖ evaluated bilaterally on knee extensors, ankle dorsiflexors, long toe extensors and ankle plantar flexors. Patient had voluntary anal contraction and normal anal sensation. ASIA sensory pin prick and light touch scores were in the normal range. Concomitant injuries included transverse process fractures of first, third and fourth lumbar vertebrae (L1, L3, L4) with dislocation, bilateral pneumothorax, fracture of eighth rib on right side and right-sided pulmonary contusion. MSCT showed multifragmentary fracture of anterior and posterior elements of L2 with dislocation and luxation. Preoperative treatment included corticosteroid therapy according to NASCIS III protocol and was continued 3 days postoperatively. Surgery was performed within 6 hours after injury. Reposition of lumbar luxation, posterior decompression, stabilization by titanium pedicle screws and rods and posterolateral fusion with autologous bone graft was done. Postoperatively patient wore a thoracolumbar orthosis for 12 weeks. Physical therapy started second day after surgery and was continued for 12 weeks. Results Patient underwent neurological and radiological evaluation 3 days and 12 weeks postoperatively. MSCT and MR imaging were performed. 3 days postoperatively ASIA impairment scale was grade D, showing neurological recovery on lower limbs with muscle grading ⅘ on knee extensors, ankle dorsiflexors, long toe extensors and ankle plantar flexors. 12 weeks postoperatively ASIA impairment scale remained D but complete motor recovery was noticed on knee extensors and long toe extensors bilaterally. Radiological examinations showed residual dislocation in L1/L2 segment with faset joints subluxation and right-sided foraminal stenosis. 12 weeks postoperatively patient was walking independently with residual motor deficit seen on ankle dorsiflexors and ankle plantar flexors on both legs. Conclusion In young patient with C-type lumbar fracture and incomplete neurological deficit open reposition, posterior decompression, posterolateral fusion and instrumented stabilization is a safe and effective procedure. It is important to involve corticosteroid therapy and to perform a surgery in early phase after traumatic incident. Our results showed that there is a great possibility of neurological recovery if the surgery is performed within ...

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