Imaging Findings

Based on the provided X-ray, CT, and MRI images, the following key features can be observed:

• Vertebral Body Structure: The thoracolumbar region (especially the T12 vertebral body) shows obvious fracture signs, including reduced vertebral height and tear-like changes. On the CT images, part of the posterior vertebral body edge protrudes into the spinal canal, suggesting possible bone fragments causing compression.
• Spinal Canal Morphology: Sagittal and axial MRI images demonstrate narrowing of the spinal canal at this level, with compression of the local dural sac. The conus medullaris region is affected, possibly accompanied by soft tissue swelling or hemorrhage.
• Soft Tissue and Spinal Cord Signal: Mixed high and low T2 signals in the conus medullaris segment suggest acute injury, edema, or compression. No obvious evidence of an intraspinal lesion such as a tumor is observed.
• Others: No significant disc herniation is noted in the adjacent intervertebral discs, and no obvious pathological changes are found in the abdomen, thorax, or sacroiliac joints.

Possible Diagnoses

Based on the imaging findings and the patient’s clinical history of a fall, the following diagnoses are considered:

1. Thoracolumbar (T12) Burst Fracture with Conus Medullaris Compression (Conus Medullaris Syndrome): This typically presents after high-energy trauma, where posteriorly displaced vertebral fragments compress the conus medullaris, consistent with the patient’s severe back pain, lower limb weakness, sensory abnormalities, and mild sphincter dysfunction.
2. Acute Disc Herniation with Cauda Equina or Conus Compression: Traumatic disc herniation is less common, but if sequestrated disc material protrudes into the dural sac, similar symptoms could appear. However, imaging does not show significant disc herniation fragments.
3. Other Intraspinal Lesions (such as Hematoma or Tumor): Acute compression might stem from an intraspinal hematoma or mass, but MRI does not indicate a notable tumor or extensive hematoma, and the clear traumatic history makes this less likely.

Final Diagnosis

Considering the patient’s age, clinical presentation (back pain, decreased lower limb strength, sensory abnormalities), history of trauma, and confirmation by CT and MRI of a T12 burst fracture with posterior fragments occupying the spinal canal, the most likely diagnosis is:

“T12 Burst Fracture with Conus Medullaris Compression (Conus Medullaris Syndrome)”

Treatment Plan and Rehabilitation

The patient has undergone posterior fixation and T12 laminectomy decompression. The subsequent treatment strategy and rehabilitation plan can be summarized as follows:

1. Surgical and Postoperative Management:
   • Continue to monitor the surgical incision healing and recovery of spinal cord and nerve function.
   • Schedule regular imaging follow-ups (at 1 month, 3 months, 6 months post-operation, etc.) to evaluate the stability of the internal fixation and spinal cord recovery.
2. Medication and Conservative Treatment:
   • Pain management with analgesics if necessary to reduce discomfort that might hinder mobility.
   • Use of neurotrophic agents (e.g., B vitamins) as prescribed, to support nerve recovery.
3. Rehabilitation and Exercise Prescription:

   Following the FITT-VP principle, a gradual and individualized approach is recommended:

   • Early Stage (Postoperative Weeks 1-4):
     • Primarily bed rest with protective measures and passive lower limb movements, along with gentle hip and knee flexion-extension exercises to maintain joint mobility.
     • As tolerated, begin short durations of ambulation out of bed while wearing a back brace. Avoid sudden torso twisting or bending.
   • Intermediate Stage (Postoperative Weeks 4-12):
     • Under physician or physical therapist guidance, begin core muscle strengthening and seated balance training.
     • Practice walking with assistive devices (walker or crutch) for 10-15 minutes each session, 2-3 times per day, gradually increasing time spent walking.
   • Late Stage (3 Months Postoperative and Beyond):
     • Gradually increase lumbar and back muscle strength exercises. For example, planks are recommended (avoiding excessive lumbar flexion or extension), starting from a few seconds to longer durations based on tolerance.
     • For aerobic exercise, consider walking on flat ground or using a stationary bike 3-5 times per week at a moderate intensity (adjusting based on heart rate and fatigue), 20-30 minutes per session.
   • Precautions:
     • Avoid heavy lifting or vigorous twisting motions of the lower back to prevent loosening of internal fixation or reinjury.
     • If there is new or worsening pain, increased weakness in the lower limbs, or more severe sensory deficits, seek medical evaluation promptly.

Disclaimer

This report is based on the information currently provided and is for reference only. It does not constitute a face-to-face medical diagnosis or treatment. Specific diagnoses and treatment plans should be determined according to the patient’s actual condition and under the guidance of professional medical personnel.