Fracture and complete dislocation of the spine with a normal motor neurology

Phadnis, Ashish; Tan, Chuan Jin; Raman, Avi; Crawford, R. J.; Rai, Am

doi:10.1016/j.injury.2006.06.112

Cited by 11 publications

(9 citation statements)

References 12 publications

(12 reference statements)

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“…However, a small subset of patients can present without spinal cord injury following a TLFD, which is considered as a rarity. 4 , 5 Most of the cases described in the literature are individual case reports or a series of few cases. 6 - 8 The present study is the largest case series of patients with fracture dislocation without cord injury.…”

Section: Discussionmentioning

confidence: 99%

“…Very rarely TLFD can present without spinal cord injury with maintained neurological function where the management presents unique difficulties to the treating surgeon. 4 , 5 Since the spinal column is grossly unstable because of the 2-column disruption, there are significant risks of further instability and neurological deficit during transfer, positioning on the operating table, and surgical intervention. 6 , 7 The spinal canal dimensions will be compromised by the translated spine and any untoward movements can risk the development of neurological deficit.…”

Section: Introductionmentioning

confidence: 99%

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Thoracolumbar Fracture Dislocations Without Spinal Cord Injury: Classification and Principles of Management

Kanna

Soundararajan

Shetty

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: Thoracic and lumbar fracture dislocations (TLFD) are high-velocity injuries and frequently result in gross neurological deficit. Very rarely, such patients present with intact neurology. Pathomechanics of injury, radiological assessment, surgical techniques, and principles of fixation in such challenging situations have not been described previously. Methods: Retrospective review of 36 patients of TLFD without cord injury was performed for demographics, clinical and radiological data, and management. The injuries were classified based on the direction of translation into 4 types: coronal translation (type 1), sagittal translation (type 2), combined translation—antero (type 3a), and combined translation—retro (type 3b). The injuries were managed by meticulous unilateral exposure and temporary fixation, decompression, gradual reduction of dislocation, and long segment fixation. Results: In 36 patients, the injuries were classified as type 1 (n = 9), type 2 (n = 10), type 3a (n = 14), and type 3b (n = 3). Imaging/intraoperative observation showed varying degrees of disintegrity of disc, facet joints, and posterior ligamentous complex in the 4 different injury types. Patients with the different injury types also needed individualistic surgical approaches to aid safe reduction of dislocation. Neurological assessment was performed using American Spinal Injury Association score (ASIA), and 16 patients had minimal neurological deficits (ASIA-D) and all were type 3 injury. The mean anteroposterior and lateral translation were corrected from 8.3 ± 3.4 to 1.7 ± 1.3 mm, and 4.7 ± 4.8 to 0.7 ± 0.8 mm respectively. Conclusion: This is the largest case series of TLFD without cord injury. Knowledge of the different injury types and principles of safe surgical reduction of the dislocation are important for the treating surgeon to ensure successful outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Thoracolumbar Fracture Dislocations Without Spinal Cord Injury: Classification and Principles of Management

Kanna

Soundararajan

Shetty

et al. 2019

Global Spine Journal

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“…6,8,9,22,24 However, surprisingly, despite the susceptibility of the thoracolumbar region to high-energy traumas and the high frequency of complete fracture dislocation in this region, neurologic sparing in such injuries was observed only in six cases. 13,14,17,19,28 Nonetheless, the explanation for such neural sparing is quite interesting because of the large discrepancy between such spectacular radiologic features and the neurologic function. The possibility of the existence of a preservation mechanism for functional integrity of the spinal cord despite gross fracture dislocation has been reported previously.…”

Section: Discussionmentioning

confidence: 99%

Complete thoracolumbar fracture-dislocation with intact neurologic function: Explanation of a novel cord saving mechanism

Asgari

Rahimizadeh

2017

The Journal of Spinal Cord Medicine

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“…4 They are usually associated with a high incidence of dural tear and paraplegia. 4 They are usually associated with a high incidence of dural tear and paraplegia.…”

Section: Discussionmentioning

confidence: 99%

“…5 Treatment of such cases is rarely described. 4,9,10 The fracture-dislocation of thoracolumbar spine has been classified based on different mechanisms. 6,7 In this study, most patients (8/11) had complete neurological deficit, and they did not recover after surgery; 2 patients had incomplete paraplegia, and they improved 1 ASIA grade after surgery.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Complete Fracture-dislocation of Thoracolumbar Spine

Wang

Zhu

2013

Journal of Spinal Disorders &Amp; Techniques

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Although difficult, satisfactory reduction of complete lumbar fracture-dislocation can be achieved through pedicle instrumentation. Intraoperative traction is necessary for the reduction procedure. Preoperative duration should be not >3 weeks. For the patient who cannot receive spine surgery in a few days after injury, preoperative traction should be applied. Covering dura sac by autologous fat graft is recommended for all the patients.

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Fracture and complete dislocation of the spine with a normal motor neurology

Cited by 11 publications

References 12 publications

Thoracolumbar Fracture Dislocations Without Spinal Cord Injury: Classification and Principles of Management

Thoracolumbar Fracture Dislocations Without Spinal Cord Injury: Classification and Principles of Management

Complete thoracolumbar fracture-dislocation with intact neurologic function: Explanation of a novel cord saving mechanism

Treatment of Complete Fracture-dislocation of Thoracolumbar Spine

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