Double-level noncontiguous thoracic Chance fractures treated with percutaneous stabilization: illustrative case

Abstract

BACKGROUND Chance fractures are unstable due to horizontal extension of the injury, disrupting all three columns of the vertebra. Since being first described in 1948, Chance fractures have been commonly found at a single level near the thoracolumbar junction. Noncontiguous double-level Chance fractures that result from a single traumatic event are rarely reported in the literature. OBSERVATIONS The authors report a case of an 18-year-old male who presented to the emergency department after a rollover motor vehicle accident. The patient complained of severe back pain when at rest and had no neurological deficits. Computed tomography revealed two unstable Chance fractures of bony subtype located at T6 and T11. The patient underwent percutaneous stabilization from T4 to T12. The postoperative assessment revealed continued 5/5 power bilaterally in all extremities, back pain, and the ability to ambulate with a walker. At 3 months after the operation, clinical assessment revealed no significant back pain and the ability to walk independently. Imaging confirmed stable fixation of the spine with no acute osseous or hardware complications. LESSONS This report complements previous studies demonstrating support for more extensive stabilization for such unique fractures. Additionally, rapid radiological imaging is needed to identify the full injury and lead patients to appropriate treatment.

Surgical management of posterior ligament complex stripping in an adolescent spinal flexion distraction injury: A case report and literature review

“…Spinal flexion distraction injuries, although rare, are a significant category of spinal injuries, particularly in adolescents. These injuries often manifest as chance fractures with consequential disruption of the PLC, which is crucial for spinal stability [ 1 , 2 , 8 , 9 ]. The primary objective of managing these injuries is to restore spinal stability and prevent further neurological deterioration, which is critical for enhancing the quality of life of the affected individuals.…”

A Comparison of Outcomes between the Wiltse Approach with Pedicle Screw Fixation and the Percutaneous Pedicle Screw Fixation for Multi‐Segmental Thoracolumbar Fractures

“…Most MSF patients are young adult males who cannot tolerate the pain caused by fractures or back braces, nor can they accept a severe decline in quality of life due to long‐term bed rest. Surgical stabilization treatment is recommended for all unstable injury segments, especially when two injury sites are close together, so that patients can start early activity and reduce the occurrence of spinal kyphosis 27–29 . Therefore, compared with single‐segment thoracolumbar fractures, the indications for MSF surgery should be appropriately relaxed.…”

“…Surgical stabilization treatment is recommended for all unstable injury segments, especially when two injury sites are close together, so that patients can start early activity and reduce the occurrence of spinal kyphosis. 27 , 28 , 29 Therefore, compared with single‐segment thoracolumbar fractures, the indications for MSF surgery should be appropriately relaxed. For surgical timing related to spinal cord injuries themselves, surgery should be performed as soon as possible after basic life support has been ensured for the patient to relieve pressure on the spinal cord nerves caused by fracture dislocation during surgery using strong internal fixation with screws or rods to restore biomechanical stability of spine as much as possible while avoiding missing the best opportunity for recovery of spinal cord nerves which will benefit early postoperative rehabilitation exercises leading toward improved quality of life.…”