Complete Fracture-Dislocation of the Thoracolumbar Spine with No Critical Neurological Deficit: A Case Report

Acute Translation Fracture of the Lumbar Spine With Increased Motoric Outcomes: A Case Report

Translation fracture of the lumbar spine is a rare but serious condition that necessitates prompt medical attention. This injury can cause nerve damage, spinal cord compression, and other complications that can affect motor function. The motoric outcomes of this fracture type depend on a variety of factors, including the severity and location of the fracture, the age and general health of the patient, and the timeliness and effectiveness of treatment. Accurate diagnosis and treatment of these injuries is important to prevent further neurological damage and improve motoric outcomes. Here we present the case of a male patient with a translation fracture at the L1-L2 level with AO spine type C who underwent immediate realignment and posterior stabilization, and subsequently participated in an early rehabilitation program, resulting in improved neurologic function. Thoracolumbar fracture with lateral dislocation is very rare and significant experience is needed to determine which management strategy can ensure the best outcome.

Clinical characteristics and treatment of fracture-dislocation of thoracic spine with or without minimal spinal cord injury

BACKGROUND

It is important to evaluate clinical efficacy and safety of posterior internal fixation using pedicle screw system.

OBJECTIVES

To investigate clinical characteristics of patients diagnosed with fracture-dislocation of the thoracic spine with or without minimal spinal cord.

METHODS

Twenty-eight patients with fracture-dislocation of thoracic spine with or without minimal spinal cord injury were retrospectively analyzed. All patients received posterior reduction and internal fixation using pedicle screw system.

RESULTS

The mean follow-up duration was 11.4 months. Among 28 patients, 24 cases were complicated with bilateral pedicle or laminal fracture. Preoperatively, the percentage of vertebral displacement was (32.1 ± 20.6)%, significantly declined to (7.5 ± 6.0)% (t= 4.575, P= 0.001) and maintained at (7.9 ± 6.3)% at the final follow-up. Preoperative local kyphosis angle was measured as (16.2 ± 11.3)∘, restored to (15.4 ± 5.9)∘ postoperatively and (15.8 ± 5.4)∘ during the final follow-up. No statistical significance was observed at three time points (all P> 0.05). The remaining 25 patients were evaluated with normal and complete neurological function. No severe complications were observed intra- and postoperatively.

CONCLUSIONS

Posterior internal fixation using pedicle screw is an efficacious and safe therapy which achieves proper reduction and preserves spinal cord function.

Fracture-dislocation of the thoracolumbar spine without neurological deficit: a report of two cases and literature review

INTRODUCTION

We report two cases of fracture-dislocation of the thoracolumbar spine without neurological deficit and outline the putative mechanisms responsible for the escape of neural tissues from injurious forces and the surgical management strategies for this type of injury. We also review similar cases described in the literature.

CASE REPORTS

A 24-year-old female with post-traumatic fracture dislocation at the T10-T11 level without neurological deficit, along with a right femoral shaft fracture, was managed with laminectomy of T10-T11 levels with bilateral facetectomy and transpedicular screws and with an intramedullary interlocking nail for the femur fracture. Another 26-year-old female (post-traumatic fracture dislocation at the T12 - L1 level treated by open reduction and pedicle screw instrumentation elsewhere) presented with implant failure and re-dislocation which was managed with laminectomy of T12- L1 levels, facetectomy and discectomy, and deformity correction, followed by 9 mm × 25 mm bullet cage insertion and fixation using transpedicular screws. Neurological function was preserved postoperatively. Both individuals returned to household activity 6 months postoperatively.

DISCUSSION

Fracture-dislocations of the thoracolumbar spine without neurological deficit have been infrequently reported. The mechanism responsible for the preservation of normal neurological function; is either posterior element fractures leading to free-floating laminae or a fracture-separation of the vertebral arch, in which pedicle fractures allow the posterior elements to remain nearly aligned, with preservation of the spinal canal integrity and maintenance of normal spinal cord function. These fracture-dislocations need to be managed carefully to achieve a good outcome.

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

BACKGROUND

The thoracolumbar junction from T11 to L2 is a common site of injury in which fracture and dislocations are the most prevalent ones occurring at this location. Fracture dislocation is defined as failure of all three columns of the spine with gross displacement. Considering the significant violence necessary to produce fracture dislocations, these injuries are often associated with major neural deficit, with the majority of casualties becoming paraplegic immediately. Preservation of neurological function following complete fracture dislocation is quite rare entity.

OBJECTIVE

To represent the possibility of existence of a preservation mechanism for functional integrity of cord despite spinal gross fracture dislocation by reproducing the injury on a plastic model and simulating a corresponding model using 3DSlicer software, detailed description the pathomechanism of neurologic sparing.

CASE REPORT

A 19-year-old female who sustained severe thoracolumbar fracture dislocation but with normal neurology is presented. Despite the severity of the condition, the diagnosis was initially missed due to associated vital injuries.

RESULTS

Combined posterior and anterior surgery resulted in optimal coronal and sagittal alignment, as well as proper stabilization without any complication. At 9-year follow-up, the patient was found to be doing well.

CONCLUSION

The prognosis for complete recovery with preplanned surgical intervention in thoracolumbar injuries affecting all three columns but with normal neurologic function is promising based on images, plastic models and 3D simulated model based on digital images.