Forensic medical assessment of thoracic and lumbar traumatic spinal cord injury in percutaneous and open transpedicular fixation.

Abstract

Objective: Aim: To conduct a forensic medical evaluation of the severity of bodily injuries in thoracic and lumbar traumatic spinal cord injury; to assess surgical care quality indicators in percutaneous and open transpedicular fixation in the context of iatrogenic risk and prevention of medical care deficiencies; to analyse whether the surgical stabilisation method may influence parameters of forensic significance for evaluating injury outcomes.

Patients and methods: Materials and Methods: A retrospective study of 269 patients: open fixation (215), percutaneous fluoroscopy-guided fixation (54). Assessed: Frankel scale, pelvic dysfunction, blood loss, duration of surgery and anesthesia, fentanyl dose, hyperthermia, and implant quality.

Results: Results: Severe bodily injury (life-threatening) was established in 27.9% (Group 1) vs 7.4% (Group 2) (p=0.001); by ≥33% permanent disability - 22.3% vs 7.4% (p=0.012). Mean permanent disability: 30.1±24.2% vs 17.8±7.9% (p<0.001). Neurological deficit (Frankel A-D) at admission: 32.4% vs 7.7%. Moderate injuries: 63.3% vs 88.9%; no mild injuries. Percutaneous technique resulted in 16.3-fold lower blood loss (20 vs 325 mL; p<0.001), lower fentanyl dose, and shorter anesthesia (p<0.001); implant quality did not differ (p>0.05).

Conclusion: Conclusions: Injury severity is a fixed legal fact determined by the primary trauma. Surgery may affect legal qualification via: change in outcome at reassessment; qualification of care defects as independent injuries. Percutaneous fixation significantly reduces iatrogenic risk. Documentation gaps complicate forensic evaluation of care quality.