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Case Reports
. 2022 Dec 23:13:593.
doi: 10.25259/SNI_1046_2022. eCollection 2022.

Delayed spinal epidural hematoma following T1 chance fracture: An illustrative case and review of the literature

Daniel Y Chu  1 , Garret P Greeneway  2 , Cody J Falls  3 , Paul S Page  2 , Azam S Ahmed  2
Affiliations
Case Reports

Delayed spinal epidural hematoma following T1 chance fracture: An illustrative case and review of the literature

Daniel Y Chu et al. Surg Neurol Int. .

Abstract

Background: A Chance fracture is a traumatic fracture of the thoracic or lumbar spine that occurs secondary to a flexion-distraction injury. Although patients with chance fractures rarely present with neurologic deficits, a subset may become symptomatic from spinal epidural hematomas (SEH) warranting emergent decompressive surgery.

Case description: An 87-year-old female on anticoagulation presented with a T1 Chance fracture after a fall. She was originally neurologically intact, but became paraplegic over the next 10 h. When the cervical/thoracic magnetic resonance revealed a SEH markedly compressing the cord between the C7-T1 levels, she underwent an emergent decompression; she also had a C5-T4 instrumented fusion. Postoperatively, she regained lower limb function, but expired on postoperative day 5 due to respiratory complications likely attributed to the prolonged surgery for the spinal instrumentation.

Conclusion: Delayed SEH rarely occur following spinal Chance fractures. Here, an 87-year-old female on anticoagulation developed the 10-h delayed onset of a SEH with paraplegia attributed to a T1 Chance fracture at the C7-T1 level. Although she regained neurological function following the emergent decompression, she expired 5 days later likely due to the extended operative time/blood loss from the C5-T4 fusion that could have been avoided.

Keywords: Anticoagulation; Chance fracture; Epidural hematoma; Spine fracture; Thoracic spine.

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Conflict of interest statement

There are no conflicts of interest

Figures

Figure 1:
Figure 1:
Sagittal cervical spine computed tomography scans demonstrating a T1 Chance fracture (panel (a), left of midline; panel (b), midline, panel (c), and right of midline).
Figure 2:
Figure 2:
T2 sagittal cervical spine MRI (panel a) and T2 axial cervical spine MRI at the T1 vertebral level (panel b) demonstrating a large dorsal epidural hematoma resulting in mass effect, severe spinal canal narrowing, and subsequent cord compression.
See this image and copyright information in PMC

References

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