No abstract

Fractures of the spinal column during rugby matches of all codes are rare but catastrophic, especially when associated with spinal cord injury. The cervical spine is vulnerable during trauma to the head and neck in contact sports. Spinal injuries reported during rugby matches have almost exclusively involved the cervical region, often with neurological sequelae. This is the first reported case of paraplegia caused by a fracture-dislocation of the thoracic spine resulting from a low velocity rugby union injury. CASE REPORTA 35 year old accountant, playing at wing forward, was admitted to our spinal injuries unit after an injury during a junior level rugby match. He had sustained a forced hyperflexion injury to his spine. The player was in a seated position, when a maul, in which he had just been involved, collapsed over him. He complained of instant severe thoracolumbar back pain associated with an immediate loss of all power and sensation from his lower abdomen distally.On examination in the emergency room, he had tenderness over his lower thoracic spine with palpable malalignment of the posterior elements at this level. A complete neurological injury with a sensory level at T12 was diagnosed. He had no associated injuries and was otherwise healthy. Of note, the patient had undergone lumbar spinal surgery 11 years previously. Anteroposterior ( fig 1A) and lateral (fig 1B) plain radiographs showed a fracture-subluxation of the T11/T12 vertebrae. The radiographs also showed previous bilateral fusions for spondylolysis of L3 and L4.The patient was nursed on a spinal bed and taken to the operating theatre. Reduction and stabilisation of the fracturedislocation with posterior instrumentation from T10 to L1 was carried out. Postoperative anteroposterior (fig 2A) and lateral ( fig 2B) radiographs showed adequate alignment of the thoracolumbar spine. The patient was subsequently transferred to a neurorehabilitation unit, but has since showed no significant neurological recovery. DISCUSSIONInjuries to the spine in rugby have been widely reported, with a high rate of cervical spine and spinal cord injury.

EV-C/D and FP open, these were 41% and 32% for reinterventions and 20% and 17% for a new bypass, respectively. The overall amputation rate was 1.2%.Conclusions: Clinical benefit for DC is excellent in AI, irrespective of TASC, and in FP segment with TASC A/B. Acceptable durability in FP TASC C/D can be achieved, however reinterventions are frequently needed, irrespective of type of revascularization.