Thoracic fracture-dislocations without spinal cord injury: a case report and literature review

Liljenqvist, U.; Halm, H.; Castro, William H. M.; Mommsen, Ulrich

doi:10.1007/bf00303421

Cited by 16 publications

(20 citation statements)

References 29 publications

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“…Only 15 cases are reported in the literature. 3,5,7,9,10,11,14,[16][17][18][19]20 They were young patients with a mean age of 34 years (range 17-66 years). The level of dislocation was between the third and the tenth thoracic vertebra: T3-T4 in two cases, T5-T6 in four cases, T6-T7 in four cases, T7-T8 in two cases, T8-T9 in one case, and T9-T10 in two cases.…”

Section: Discussionmentioning

confidence: 99%

“…1,4,8,12,13 Thoracic spine fracture-dislocations that are not accompanied by neurological damage are extremely rare, and only a few cases are described in the literature. 3,5,7,9,10,11,14,[16][17][18][19]20 We present here a case of complete posterior dislocation of the first thoracic vertebra over the second without neurological damage, and we discuss its surgical treatment.…”

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confidence: 95%

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Case report of complete dislocation of T1–T2 without neurological deficit and review of the literature

Iure¹,

Fravisini²,

Boriani³

2005

Injury Extra

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Fracture-dislocations of the thoracic spine comprise about 16% of all thoracic and lumbar fractures, 4 and are commonly caused by high-speed road accidents. Unlike the cervical spine, the thoracic spine is stabilized by its connection to the rib cage by transverse costal ligaments. The position of the articular facets provides resistance to axial rotation and horizontal translation. 1,4 Therefore, a severe injury is required to bring about a fracture-dislocation at this level. These injuries, due to the narrowness of the thoracic canal and the precarious blood supply of the cord, lead to complete paraplegia in more than 80% of cases. 1,4,8,12,13 Thoracic spine fracture-dislocations that are not accompanied by neurological damage are extremely rare, and only a few cases are described in the literature. 3,5,7,9,10,11,14,[16][17][18][19]20 We present here a case of complete posterior dislocation of the first thoracic vertebra over the second without neurological damage, and we discuss its surgical treatment. Case reportA 21-year-old man was involved in a motorcycle accident and suffered multiple injuries. He did not lose consciousness, and was taken to a nearby hospital by ambulance. Radiographs of the thoracic spine were taken (Fig. 1), as well as CT scans of the head, chest and abdomen. These revealed pulmonary contusions, bilateral haemothoraces, bleeding from the bottom of the left kidney, damage to the left ureter, and fractures of the 10th and 12th ribs. Two days later the ureteric lesion was treated with a stent. Later, the patient began to complain of back pain and paraesthesia in the lower limbs. A CT scan and MRI of the thoracic spine revealed an initially unidentified T1-T2 fracture-dislocation (Figs. 2 and 3). The patient was brought to our hospital for treatment.On admission, the patient's general condition was good. He had no motor deficits, and sensitivity had returned to normal.We decided to reduce and stabilize the dislocation surgically. First, we performed a T1 and T2 wide laminectomy and a complete excision of the T1-T2 disc by a posterolateral approach (so as to reduce the amount of overlap between the two segments of thoracic spine). By combined traction and leverage, Injury Extra (2005) 36, 503-507

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 95%

Case report of complete dislocation of T1–T2 without neurological deficit and review of the literature

Iure¹,

Fravisini²,

Boriani³

2005

Injury Extra

View full text Add to dashboard Cite

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“…1 A fracture dislocation in this region generally involves high-energy trauma, such as a motor-vehicle accident, crush injury or fall from height. [3][4][5][6] Notably, the patient in our case had been conscious preoperatively and was assessed to have intact neurology. [2][3][4] Nevertheless, even with complete fracture dislocation of the thoracic spine, sparing of the spinal cord is possible if the posterior spinal elements (i.e.…”

mentioning

confidence: 94%

“…bilateral pedicles or facets) become dissociated from their vertebral bodies, leading to spontaneous widening of the spinal canal. [3][4][5][6] Notably, the patient in our case had been conscious preoperatively and was assessed to have intact neurology. However, if a similar injury was to occur where neurological function cannot be readily assessed, such as in an unconscious patient, our experience suggests that it may still be reasonable to assume fortuitous sparing of the spinal cord.…”

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confidence: 94%

Traumatic fracture dislocation of the thoracic spine sparing both the spinal cord and aorta

Zhu

Mannambeth

McGiffin

et al. 2017

ANZ Journal of Surgery

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Traumatic fracture dislocation of the thoracic spine sparing both the spinal cord and aorta A 33-year-old man was involved in a high-speed, motorcycle accident, striking his back on metal railing by the side of the highway. On arrival at our trauma centre, the patient was hypotensive (86/60 mmHg) and tachycardic (110 beats/min). He was fully orientated, with intact power and sensation in all limbs.

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“…3. Versorgungsbilder nach ventraler Reposition und Plattenspondylodese von BWK 11 auf LWK 1 wirbelkörper im Bereich Th 6-Th 9 ohne konsekutive Ausfälle zusammen [8]. Nahezu alle Verletzungen traten nach Hochrasanztrauma ein.…”

Section: Introductionunclassified

Luxationsfraktur des 12. Brustwirbelkörpers ohne Schädigung des Rückenmarks

Militz

Bühren

1998

Trauma und Berufskrankheit

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Verletzungen der Wirbelsäule mit einer Instabilität in 3 Ebenen ziehen in einem hohen Prozentsatz der Fälle eine Schä-digung der nervalen Strukturen im Spinalkanal mit sich [4,6,7,13]. Bei Anwendung der Klassifikation von Magerl muß bei der Verletzung des Typs C in 55% der Fälle mit einem neurologischen Defizit gerechnet werden [10,11].Die Wirbelsäule im thorakalen Bereich stellt aufgrund ihres anatomischen Aufbaus und der ventralen Stabilisierung durch den Rippenkäfig gegenüber HWS und LWS einen relativ stabilen und rigiden Wirbelsäulenab-schnitt dar. Frakturen werden epidemiologisch deutlich seltener gesehen als beispielsweise für den thorakolumbalen Übergang und präsentieren sich dann zumeist als Stauchungsfrakturen in der thorakalen Kyphose zwischen Th 6 und Th 9.Die Inkorporation der Brustwirbelsäule in den Rippenkäfig bietet eine effektive Prävention gegen die Luxation der thorakalen Facettengelenke. Folglich ist für das Auftreten von dislozierten Luxationsfrakturen im Bereich der Brustwirbelsäule eine sehr hohe Traumarasanz erforderlich. Denis u. Burkes beobachteten 12 Fälle bei Holzfällerarbeiten, wobei alle Patienten eine komplette Paraplegie erlitten [3]. McAfee et al. beschrieben 11 Fäl-le derartiger Translationsverletzungen, wobei lediglich in 1 Fall die Neurologie noch intakt war [12]. Im eigenen Patientengut werden derartige Verrenkungsverletzungen der Brustwirbelsäule nach Unfällen mit hoher Rasanz, z. B. bei Motorradfahrern und Gleitschirmfliegern, gehäuft gesehen. Aufgrund der geringen Reservekapazität des Spinalkanals im Bereich der Brustwirbelsäule gehen diese Verletzungen leider praktisch immer Trauma Berufskrankh (1998) 1 : 71-73 © Springer-Verlag 1998

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Thoracic fracture-dislocations without spinal cord injury: a case report and literature review

Cited by 16 publications

References 29 publications

Case report of complete dislocation of T1–T2 without neurological deficit and review of the literature

Case report of complete dislocation of T1–T2 without neurological deficit and review of the literature

Traumatic fracture dislocation of the thoracic spine sparing both the spinal cord and aorta

Luxationsfraktur des 12. Brustwirbelkörpers ohne Schädigung des Rückenmarks

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