Complete Fracture-Dislocation of the Thoracic Spine Without Neurologic Deficit

Korovessis, Panagiotis; Sidiropoulos, Panagiotis; Dimas, Anastasios

doi:10.1097/00005373-199401000-00022

Cited by 31 publications

(32 citation statements)

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“…2,5,6,[8][9][10][12][13][14][15][16][17][18] Under certain rare circumstances, however, despite significant anterior-posterior or lateral displacement, the patient can remain neurologically intact or be only mildly affected. 9,10,12,14,17,18 The reason for such neural sparing is quite interesting because a great discrepancy exists between the spectacular radiological features and the neurological picture.…”

Section: Discussionmentioning

confidence: 99%

“…12 Later, in 1976, Sir Ludwig Guttman reported 2 more cases in which, despite gross lateral displacement, one patient was neurologically intact and the other showed only a mild neural deficit, demonstrating that the neural arch fracture was the cardinal factor in neurological sparing. 9,14 Since the publication of Guttman's cases, only a few cases of traumatic thoracic spondyloptosis in patients with normal neurological status have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…9,14 Since the publication of Guttman's cases, only a few cases of traumatic thoracic spondyloptosis in patients with normal neurological status have been reported. 9,10,12,14,17,18 According to these reports, bilateral fractures at the vertebral body-pedicle junction exert a protective effect by enlarging the canal through spontaneous decompression of the spinal cord. Through these consecutive events, the posterior elements maintain their continuity, sparing the integrity of the spinal cord and preserving neurological function despite gross displacement of the vertebral body.…”

Section: Discussionmentioning

confidence: 99%

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Management of traumatic double-level spondyloptosis of the thoracic spine with posterior spondylectomy: case report

Rahimizadeh

2015

SPI

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Traumatic spondyloptosis of the thoracic spine is an uncommon injury. In most cases, spondyloptosis is confined to one vertebral body, whereas double-level spondyloptosis is extremely rare. Most patients who sustain traumatic spondyloptosis immediately become paraplegic, but in some cases neurological function is preserved. If this occurs, it is due to detachment of the pedicles from the corresponding vertebral body, resulting in spontaneous decompression of neural elements. Herein, the authors describe a case of undetected traumatic double-level spondyloptosis in the upper thoracic region in an adult male patient who was neurologically intact for 2 days but later became paraplegic. Initially, management of this pathology seemed a very challenging scenario. However, with review of the reconstructed CT images and reproduction of the injury on a plastic model, a posterior-only approach was chosen as an alternative operative solution for this catastrophic injury. Via this single-stage posterior approach, long-segment pedicle screw/rod instrumentation resulted in successful reduction, restoration of alignment, and stabilization after 1-level posterior spondylectomy. To the best of the authors’ knowledge, this is the first example reported in the literature of double-level spondyloptosis of the thoracic and the lumbar spine. This report describes the rationale, mechanism, and technical details afforded for reduction and stabilization of this rare injury.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Management of traumatic double-level spondyloptosis of the thoracic spine with posterior spondylectomy: case report

Rahimizadeh

2015

SPI

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“…Ryan et al [7] reported on missed thoracic injuries that may associate with spinal cord trauma: hemopneumothorax, pneumothorax, paralyzed hemidiaphragm. Several reports of fracture-dislocations in the thoracic spine without associated spinal cord injury have been published [4,5]. Two recent papers reported on the presence of air in the spinal canal in conjunction with thoracic trauma [2,3].…”

Section: Discussionmentioning

confidence: 99%

“…Spinal trauma frequently results from high-energy vehicular accidents, which may produce multisystem trauma [2][3][4][5]7]. Because of the priorities of resuscitation, other injuries may escape early diagnosis.…”

Section: Introductionmentioning

confidence: 99%

Unrecognized laceration of main bronchus caused by fracture of the T6 vertebra

Korovessis

Stamatakis²,

Baikousis³

1998

European Spine Journal

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IntroductionSpinal trauma frequently results from high-energy vehicular accidents, which may produce multisystem trauma [2][3][4][5]7]. Because of the priorities of resuscitation, other injuries may escape early diagnosis. This study reports on an extremely rare case of laceration of the bronchus by fragments of a bursting vertebral fracture that was not diagnosed on admission. Case reportA 58-year-old man riding a motorcycle was hit by a car. On admission, the patient was in an excellent general condition, without cardiovascular or respiratory complaints. Physical examination revealed displaced ankle fractures bilaterally and a displaced olecranon fracture on the left. Lateral roentgenograms of the spine revealed a fracture of the T6 vertebra, while the CT scan revealed a bursting of its vertebral body (Fig. 1). Lung sounds and respiratory airway pressures were normal and the roentgenograms of the thorax in supine position were within normal limits; in particular, no hemothorax or pneumothorax was found. Ultrasound scanning of the abdomen (to examine the liver and spleen parenchyma and check for bleeding) [1] revealed no pathological findings in the abdominal cavity or retroperitoneal space. The neurologic examination showed regular intrinsic muscle reflexes, both motor and sensory, in the upper and lower extremities. Two days after admission it was planned to stabilize the ankle and olecranon fractures under general anesthesia. The patient was placed in supine position for introduction of the general anesthesia. Immediately after introduction of the endotracheal tube and application of positive pressure by the anesthetist, a curious sound was observed inside the chest, which was followed by an increasing distention of the abdomen, without reverse filling of the ventilation balloon during the passive expiration. In other words, the volume of air passively inspirated through the tube was not followed by the passive expiration of an equal air volume. There appeared to be a significant concentration of the mechanically inspirated air somewhere inside the body. Initially it was supposed that the tube was not correctly positioned in the trachea. Thus, although the anesthetist performed repeated intubations in order to secure absolutely correct intubation (avoiding the esophagus, ensuring good contact of the tube on the inner surface of the trachea, etc.), the result was always the same. An increasing distention of the abdomen was observed during ventilation of the lungs with positive pressure, whereas when the tube was removed the distention decreased in a few seconds. Repeated blood gas analyses showed normal saturation and base levels, and the PO 2 , PCO 2 , and PH values were within normal limits for the age, height, and sex of the patient. Further anteroposterior and lateral chest roentgenograms in supine position on the operation table AbstractWe report on an extremely rare case of a 58-year-old male polytraumatized patient who sustained a bursting fracture of the T 6 vertebral body associated with laceration o...

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