Traumatic Thoracic Spine Fracture Dislocation with Minimal or No Cord Injury

Scott A. Shapiro, MD

Introduction:

Thoracic fracture dislocation leads to an 80% rate of paraplegia and it is rare to remain neurologically normal with only 11 documented cases. We report 4 cases and analyze them with the other 11 cases.

Results:

There were 10 males and 5 females with a mean age of 34(l7–66). Eleven were normal on admission, 2 had intercostal neuralgia and 2 had 4/5 leg weakness. All had thoracic pain with 14/15 rib fractures and 8 hemothorax. All had lateral translation with a mean of 12 mm(3–27mm). There were 6 with associated anterior subluxation with a mean of 12 mm(4–23 mm)(all had one body fractureinto an adjacent vertebral body). There were 6 burst fractures with translation with a mean kyphosis of 38 degrees(28–50). All 15 had bilateral pedicle fractures at the site of subluxation, separating anterior from posterior elements leading to canal preservation. Only 211 5 had 100% spondyloptosis. Five were succesfully managed nonoperatively and 3/5 remained x–ray unchanged and 2/5 less subluxation but not anatomic. Ten underwent successful internal fixation with 2 anterior, 5 posterior and 3 combined. All improved or remained normal. Three were x–ray unchanged, 11 improved but not anatomic and 1 was anatomic.

Conclusion:

Rarely, due to bilateral pedicle fractures at the site of dislocation, the spinal canal and cord are preserved. The results appear to justify internal fixation with some or no reduction and/or prolonged bed rest to successfully treat these cases.