Treatment of severe double spinal cord injuries

Abstract

This is a case report describing an injury ± sustained by a 25-year-old man during a car accident, and characterized by fracture dislocation of the spine at the level of C7 and T4 accompanied by pulmonary contusion. He had an incomplete spinal cord lesion at the level of C7 and a complete lesion at the level of T4 (T4 ASIA A). Imaging of the spine showed three column fractures with ventral spinal cord compression at both levels. Discussants of this case comment on the concept of acute treatment of severe double spinal cord injuries, and present their chosen way of management in this particular case. Spinal Cord (2001) 39, 492 ± 497Keywords: double injuries of the spine; incomplete spinal cord injury; complete spinal cord injury; primary treatment; neurological recovery Case presentationA 25-year-old male was admitted after a car accident. He su ered severe low cervical and upper thoracic spine injuries. On admission the neurologic examination revealed complete motor function loss from the level of C7, incomplete sensory loss from C7 to T3, and complete loss of both motor and sensory functions from the level of T4 with over¯ow incontinence (Frankel B from C7 to T3, and Frankel A from T4, ASIA motor score 10, sensory score 52). Megadose methylprednisolone treatment was administered according to NASCIS 3, starting 1 h after injury. Xray, CT scan and MRI showed three column fractures both in the levels of C7 and T4 with ventral encroachment and severe medullary compression at both levels. The most informative MRI pictures revealed contusion and traumatic oedema of the spinal cord at both of the injured levels ( Figure 1). The chest X-ray showed mild pulmonary contusion. He had no other injuries. His primary laboratory parameters were normal.

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

“…7 Double-level three-column injuries have been reported more recently in the literature with a primary focus on fracture dislocations. [8][9][10][11][12] Few reports have been released in the literature focusing on purely double-level Chance fracture. 13,14 The typical mechanism of injury for Chance fractures is attributed to an MVA, where the individual experiences rapid deceleration while wearing a lap seat belt.…”

Floating Thoracic Spine Due to Noncontiguous Fracture-Dislocations of the Thoracolumbar Spine

“…We present a case of a young male who sustained noncontiguous fracture-dislocations of the thoracolumbar spine following an unrestrained high-velocity motor vehicle collision. Such an injury pattern has been reported quite infrequently; two case reports were involving the thoracic spine only and rest with lumbosacral and cervical involvement [3][4][5][6][7][8]. Written and informed consent was taken from the patient and his family members for using his individual and clinical data for publication and research purposes.…”