Ascending paralysis after thoracolumbar fracture: 3 cases reports and related literature review

Objective To investigate the clinical features and treatment of ascending paralysis after thoracolumbar fracture.Methods Three male patients with 2 fracture levels at T12 and one at L1 were retrospectively studied.Their mean age was 41.3 years (range,39-42 years).All 3 cases were undertaken open decompression,reduction and internal fixation.Paralysis level began to ascend at 2-5 days after injury,with 2 cases up to C2,3 and 1 case up to T7.Two patients suffered irritating pain over the paralysis level before onset of ascending.Postoperative MRI images demonstrated well reduction and no compression of spinal cord.In the early phase after ascending,MRI obviously showed swelling in spinal cord and long T1 and long T2 signals shaped patchy and stripy distribution in the central area.One patient's MRI displayed that the spinal cord shrinked 16 days after trauma with abnormal high signal in the central area.Results Two cases died of respiratory muscle paralysis and 1 case suffered paraplegia with no recovery 5 years after surgery.Conclusion Ascending paralysis after thoracolumbar fracture is a rare complication with very poor prognosis.MRI is available for evaluating operational effects and affected level.The exact mechanism and effective treatment are still unclear and need further investigated. Key words: Spinal fractures;  Paraplegia;  Postoperative complications