Severe thoracic spinal fracture-dislocation without neurological symptoms and costal fractures: a case report and review of the literature

Abstract

Introduction: Only a high-energy force can cause thoracic spinal fracture-dislocation injuries, and such injuries should always be suspected in patients with polytrauma. The injury is usually accompanied by neurological symptoms. There are only a few cases of severe thoracic spinal fracture-dislocation without neurological symptoms in the literature, and until now, no case of severe thoracic spinal fracture-dislocation without neurological symptoms and without costal fractures has been reported.

Case presentation: A 30-year-old Han Chinese man had T6 to T7 vertebral fracture and anterolateral dislocation without neurological symptoms and costal fractures. The three-dimensional reconstruction by computed tomography and magnetic resonance imaging indicated the injuries in detail. A patient with thoracic spinal fracture-dislocation without neurological symptoms inclines to further dislocation of the spine and secondary neurological injury; therefore, laminectomy, reduction and internal fixations with rods and screws were done. The outcome was good. Severe spinal fracture-dislocation without neurological symptoms should be evaluated in detail, especially with three-dimensional reconstruction by computed tomography. Although treatment is individualized, reduction and internal fixation are advised for the patient if the condition is suitable for operation.

Conclusions: Severe thoracic spinal fracture-dislocation without neurological symptoms and costal fractures is frighteningly rare; an operation should be done if the patient's condition permits.

Figure 1

Three-dimensional reconstruction of computed tomography showed spinal fracture-dislocation of T6 to T7.

Figure 2

Three-dimensional reconstruction of computed tomography showed a fracture of right clavicle and non-fracture of ribs.

Figure 3

Magnetic resonance imaging showed spinal fracture-dislocation of T6 to T7.

Figure 4

Horizontal computed tomography scans showed a large bilateral hemothorax; fractures of bilateral pedicles of vertebral arch.

Figure 5

Horizontal computed tomography scans showed a large bilateral hemothorax; three vertebral levels in one cut.

Figure 6

Anteroposterior thoracic spine plain X-ray showed spinal fracture-dislocation of T6 to T7.

Figure 7

Anteroposterior thoracic spine plain X-ray showed realignment of the fractured-dislocated spine.