Thoracolumbar Fracture with Preservation of Neurologic Function

Abstract

A 44-year-old man presented to the emergency department with severe pain after an accident at the gym. He reported he had been doing squats while balancing a 200-kg bar across his trapezius. His knee gave way and he fell to the floor, with the weight landing on his lower back. The patient managed to crawl out from under the weight but did not attempt to walk. On arrival at the emergency department he had full power in both lower limbs and normal sensation to light touch in all dermatomes of the lower limbs. The area over vertebral bodies T11 through L2 was exquisitely tender. Initial frontal and lateral plain films (Panels A and B, respectively) and an axial computed tomographic study of the area from T12 through L1 (Panel C) showed fracture-dislocation. The patient was taken to the operating room that night for open reduction and internal fixation of the fracture-dislocation of vertebral bodies T12 through L1. Postoperatively, he had preservation of normal neurologic function, with the exception of mild paresthesia on both sides of his trunk in a T12 dermatomal distribution.

Clinical case-series report of traumatic cauda equina herniation

“…The bony end plates and cortical margins of the vertebral body can be fractured by axial loading due to high-energy forces, [7–10] A radial displacement of corticocancellous bone fragments will occur when the vertebral body is compressed. Retropulsion of these bone and disc fragments into the spinal canal will impact the neural structures, resulting in displacement of the dural sac in the posterior direction and narrowness of the spinal canal.…”

Surgical Considerations to Improve Recovery in Acute Spinal Cord Injury

“…129 Unlike in the cervical region, the posterior approach is considered the primary choice for acute thoracolumbar decompression for a number of reasons: less vascular/abdominal structures to navigate around when approaching posteriorly, better visualization of the spine, and surgeons generally are trained more in this approach compared to anteriorly. 130,131 Recent studies have begun examining whether the anterior approach is actually inferior to the posterior. They have shown no neurologic recovery difference between anterior and posterior approaches.…”

“…Fracture dislocations are generally associated with severe neurological dysfunction on presentation and require immediate surgical decompression via posterior pedicle screw fixation after the patient has been medically stabilized [ 129 ]. Unlike in the cervical region, the posterior approach is considered the primary choice for acute thoracolumbar decompression for a number of reasons: less vascular/abdominal structures to navigate around when approaching posteriorly, better visualization of the spine, and surgeons generally are trained more in this approach compared to anteriorly [ 130 , 131 ]. Recent studies have begun examining whether the anterior approach is actually inferior to the posterior.…”