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Case Reports
. 2021 Feb 10:32:100409.
doi: 10.1016/j.tcr.2021.100409. eCollection 2021 Apr.

Corrective osteotomy of global sagittal imbalance in the neglected fracture-dislocation thoracic spine

Torphong Bunmaprasert  1 , Nattharut Chaibhuddanugul  1 , Jakkrit Keeratiruangrong  1 , Raphi Raphitphan  1 , Nantawit Sugandhavesa  1 , Wongthawat Liawrungrueang  1
Affiliations
Case Reports

Corrective osteotomy of global sagittal imbalance in the neglected fracture-dislocation thoracic spine

Torphong Bunmaprasert et al. Trauma Case Rep. .

Abstract

Background: Neglected fracture-dislocation thoracic spine without neurological deficit is an extremely rare injury. Current studies reveal that global sagittal balance is very important for quality of life (QOL). Complex deformity causes difficulty with dissection in the surgical planning and type of spinal osteotomy. Restoration of global balance parameters are related to a successful outcome, if the surgeon understands the morphology of complex bone deformity and the surgical tactics of spinal osteotomy.

Case presentation: A 23-year-old female presented with untreated thoracic kyphotic deformity without paraplegia (ASIA E), following a motor vehicle accident 2 months earlier. Radiographic imaging and computed tomography scan revealed a complex fracture-dislocation at the T8-T9 level with kyphosis deformity, abnormal C7 plump line, and 65 degrees of sagittal Cobb's angle (T7-T11). The multilevel Ponte osteotomy surgical technique was performed at the apex of the kyphosis. After the patient underwent corrective osteotomy and instrumentation, postoperative radiograph and CT scan revealed 24 degrees of sagittal Cobb's angle (T7-T11). The patient's balance was recovered when followed up at 1 year. The patient's quality of life was improved and thus she was extremely satisfied with this treatment.

Conclusion: Neglected fracture-dislocation thoracic spine without neurological deficit is rarely seen. It is a complex deformity injury. In this case, we performed multilevel Ponte osteotomy, instead of osteosynthesis, to restore the complex deformity that was affecting global balance. Successful outcomes are the result of good surgical preoperative planning and the surgical tactics of spinal osteotomy.

Keywords: Kyphosis deformity; Neglected fracture-dislocation; Spinal osteotomy.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1
CT scan of the patient (1A). The coronal plane shows the fracture-dislocation at the T8–9 level. The proximal part (T8 vertebra) displaced to the right side, and the distal part (T9 vertebra) migrated proximally and displaced to the left side (1B). The sagittal plane shows multilevel fractures and kyphotic deformity at the thoracic spine. Panel 1C shows widening of the spinal canal and no retropulsion fragment. Axial MRI at T9–T10 shows that the left-side neural foramen was compromised (1D).
Fig. 2
Fig. 2
It shows malalignment of the spine (2A), multilevel Ponte osteotomies at the T8–10 level (2B), rod rotation techniques (2C), and final construction (2D).
Fig. 3
Fig. 3
Plain radiographs pre-operative (3A, 3B) and post-operative (3C, 3D).
Fig. 4
Fig. 4
CT reconstruction pre-operative (4A, 4B) and post-operative (4C, 4D).
See this image and copyright information in PMC

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