Upper Thoracic spine(D2-D3) fracture-dislocation without Spinal cord injury â€“ a case report
Fracture dislocations of the thoracic spine in extremly rare and when it occurs,it is considered the most unstable of spinal injuries and is almost always associated with injury to the spinal cord due to narrow spinal canal dimensions.Very few neurologically intact cases of thoracic spine fracture dislocation have been reported in the literature ,which are mostly around the dorsolumbar junction and none in the upper thoracic spine.Here we report a case of 44 years old man who was in a road traffic accident and diagnosed with fracture dislocation of D2 over D3 vertebra with no neurological deficit.Patient was treated with Posterior spinal stabilization,reduction and D2 laminectomy.Patient remanined neurologically intact post operatively.Here we discuss the significance of this injury and the neural sparing mechanism of posterior neural arch disruption(bilateral pedicle fracture and lamina fracture),whichÂ preserves the spinal canal and the spinal cord from being damaged.We also discuss about the usefulness of CT scan and MR imaging in these injuries and the surgical approaches used in treating them.
Keywords-fracture dislocation,thoracic spine,surgical approachesÂ
2. Sixta S, Moore FO, Ditillo MF, Fox AD, Garcia AJ, Holena D, et al. Screening for thoracolumbar spinal injuries in blunt trauma: An Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg 2012;73 5 (Suppl 4):S326-32.
3. Roaf R. A study of the mechanics of spinal injuries. J Bone Joint surgery 1960;42(4):810-23.
4. Denis F. The three column spine and its significance in the classification of acute thoracolumbar spinal injuries. Spine (Phila Pa 1976) 1983;8(8):817-31.
5. Denis F. Spinal instability as defined by the three-column spine concept in acute spinal trauma. Clin Orthop Relat Res 1984;(189):65-76.
6. Provenzale J. MR imaging of spinal trauma. Emerg Radiol 2007;13:289-97.
7. Lee RA, van Zundert AA, Breedveld P, Wondergem JH, Peek D, Wieringa PA. The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging (MRI). Acta Anaesthesiol Belg 2007;58(3):163-7.
8. Bohler L. Die The technique of bone fracture treatment in peace and in wars. 9th-11th ed., Vol. 1. Berlin, Germany: Maudrich; 1943.
9. Liljenqvist U, Halm H, Castro WH, Mommsen U. Thoracic fracture-dislocations without spinal cord injury: A case report and literature review. Eur Spine J 1995;4(4):252-6.
10. Gitelman A, Most MJ, Stephen M. Traumatic thoracic spondyloptosis without neurologic deficit, and treatment with in situ fusion. Am J Orthop (Belle Mead NJ) 2009;38(10):E162-5.
11. Obeid I, Guerin P, Gille O, Gangnet N, Aurouer N, Pointillart V, et al. Total vertebrectomy and spine shortening in the management of acute thoracic spine fracture dislocation-technical note and report of 3 cases. J Spinal Disord Tech 2011;24(5):340-5.
The publication is licensed under CC By and is open access. Copyright is with author and allowed to retain publishing rights without restrictions.