Complete fracture-dislocation of the thoracolumbar spine without neurological deficit

Zeng, Junfeng; Gong, Qiyong; Líu, Hao; Xiao, Rong; Ding, Chen

doi:10.1097/md.0000000000010050

Cited by 18 publications

(21 citation statements)

References 11 publications

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“…The latter had a good correction of deformity and a low residual kyphosis over the long term [7]. Although this support remains a controversial subject, many authors agree on a posterior approach with a long instrumentation [11].…”

Section: Discussionmentioning

confidence: 95%

Thoracic and Lumbar Spine Fracture, Type C of Magerl: About Two Cases and Review of Literature

Gaye¹,

Ilunga²,

Sylla³

et al. 2020

OJO

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Introduction: Thoracic and lumbar spine fracture, type C of MAGERL is one of the most biomechanically and neurologically unstable lesions, induced by significant damage to the bone, disk and ligament complex. Materials and Methods: We report two cases of Thoracic and lumbar fracture, type C of MAGERL hospitalized in the Neurosurgery department of the Grand Yoff General Hospital in Dakar during a period from June 2014 to June 2017. Observations: 1 st case: 44-year-old patient, referred from abroad because of multi systemic trauma related on road traffic accident. On physical examination sustained a thoracic spine trauma classified ASIA D. Body CT scan showed T4-T5 fracture-dislocation Type C of MAGERL, multiple ribs fracture with a right slight haemothorax, a sternal, a left humerus and scapulas fracture. Thoracic Posterior approach was done using laminar hooks. Clinical and anatomical results are good. 2 nd case: 20-year-old patient, referred for thoracolumbar trauma because of occupational accident. The initial clinical examination classified it ASIA B. CT scan investigation, demonstrated a L1-L2 fracture type C of MARGEL. Thoraco lumbar spine posterior approach was done using pedicular screw fixation. Two years after trauma the patient recovered completely from his paraplegia. Conclusion: Thoracic and lumbar spine fractures, type C of MAGERL are compelling and instable fracture. Performing posterior instrumentation can achieve a good stabilization and reduction of the lesion.

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Section: Discussionmentioning

confidence: 95%

Thoracic and Lumbar Spine Fracture, Type C of Magerl: About Two Cases and Review of Literature

Gaye¹,

Ilunga²,

Sylla³

et al. 2020

OJO

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show abstract

“…In addition, short bony fusion, that is, posterolateral or interbody fusion, should be applied [9] [11] [12] [29]. Junfeng Z et al [21], for a complete fracture-dislocation in 38-year-old patient, performed a long instrumentation and long posterolateral fusion for fixation to avoid implant failure. He obtained a solid fusion and a satisfactory outcome at the 23-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature

Ilunga¹,

Diop²,

Faye³

et al. 2021

OJO

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Background: Thoracolumbar spine fracture-dislocations are very unstable and usually secondary to high energy trauma. Due to disruption of the entire vertebrae columns, the absence of neurological deficit is exceptional. Aim: The purpose of this work is to report our experience in the management of this entity in a context of limited resources and to make a review of the literature. Case presentation: A 30-year-old man was admitted with a severe low back pain after a traffic accident. Neurological functions were intact after examination. Radiological assessments revealed a complete L3-L4 fracture-dislocation. The patient underwent an open posterior reduction and internal long segment fixation. The post-operative was marked by a surgical site infection treated with surgical debridement and targeted antibiotic therapy. The neurological functions were preserved. Conclusion: Fracture-dislocations of the thoracolumbar spine are caused by high energy trauma and are remarkably unstable lesions. When they are associated with intact neurorological functions, reduction and stabilization of these fractures are a challenge.

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“… 10 Fractures of the pedicles and facets at the involved vertebrae have been reported in a few case reports. 11 - 14 The fractured pedicles and facets dissociate the vertebral body from the posterior vertebral arch, which results in translation of the vertebral segments but the spinal cord may have enough space to avoid any injury.…”

Section: Discussionmentioning

confidence: 99%

“…In 2 previous case reports of TLFD without neurology, this mode of injury has been described. 13 , 14 …”

Section: Discussionmentioning

confidence: 99%

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Thoracolumbar Fracture Dislocations Without Spinal Cord Injury: Classification and Principles of Management

Kanna

Soundararajan

Shetty

et al. 2019

Global Spine Journal

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Study Design: Retrospective cohort study. Objectives: Thoracic and lumbar fracture dislocations (TLFD) are high-velocity injuries and frequently result in gross neurological deficit. Very rarely, such patients present with intact neurology. Pathomechanics of injury, radiological assessment, surgical techniques, and principles of fixation in such challenging situations have not been described previously. Methods: Retrospective review of 36 patients of TLFD without cord injury was performed for demographics, clinical and radiological data, and management. The injuries were classified based on the direction of translation into 4 types: coronal translation (type 1), sagittal translation (type 2), combined translation—antero (type 3a), and combined translation—retro (type 3b). The injuries were managed by meticulous unilateral exposure and temporary fixation, decompression, gradual reduction of dislocation, and long segment fixation. Results: In 36 patients, the injuries were classified as type 1 (n = 9), type 2 (n = 10), type 3a (n = 14), and type 3b (n = 3). Imaging/intraoperative observation showed varying degrees of disintegrity of disc, facet joints, and posterior ligamentous complex in the 4 different injury types. Patients with the different injury types also needed individualistic surgical approaches to aid safe reduction of dislocation. Neurological assessment was performed using American Spinal Injury Association score (ASIA), and 16 patients had minimal neurological deficits (ASIA-D) and all were type 3 injury. The mean anteroposterior and lateral translation were corrected from 8.3 ± 3.4 to 1.7 ± 1.3 mm, and 4.7 ± 4.8 to 0.7 ± 0.8 mm respectively. Conclusion: This is the largest case series of TLFD without cord injury. Knowledge of the different injury types and principles of safe surgical reduction of the dislocation are important for the treating surgeon to ensure successful outcomes.

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Complete fracture-dislocation of the thoracolumbar spine without neurological deficit

Cited by 18 publications

References 11 publications

Thoracic and Lumbar Spine Fracture, Type C of Magerl: About Two Cases and Review of Literature

Thoracic and Lumbar Spine Fracture, Type C of Magerl: About Two Cases and Review of Literature

Thoracolumbar Spine Fracture-Dislocation without Neurological Deficit: A Case Report and Review of the Literature

Thoracolumbar Fracture Dislocations Without Spinal Cord Injury: Classification and Principles of Management

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