Fracture-dislocation Of Thoracic Spine Research Articles

Chylothorax Management Four Years Post Spine Surgery: A Successful Conservative Treatment

Background: Chylothorax is a pathological condition associated with a high mortality and morbidity rate. The first observation of chylothorax associated with thoracic vertebral injury was documented by Krabbell in 1885. Since then, several cases have been described in the literature.
 Non traumatic chylothorax several years after spine surgery is a rare condition. We described a case of a patient who sustained a thoracic spine fracture-dislocation and presented with a right sided chylothorax as a late complication to his thoracic spine trauma. A right thoracentesis was performed, providing partial relief of respiratory symptoms. The collected fluid was sent to the laboratory for further examination. Biochemical analysis of the milky pleural fluid confirmed the suspicion of chylothorax, with elevated levels of triglycerides and lymphocytes. These findings supported the diagnosis of chylothorax.
 Conclusion: Non-traumatic chylothorax occurring several years after spine surgery is a rare condition, and there is limited literature available on this particular pathology. The diagnosis can be simplified through laboratory examination of the milky fluid. Conservative treatment is typically the approach of choice in the majority of cases, involving total parenteral nutrition and the insertion of a chest tube into the chest cavity, followed by chemical pleurodesis.

Novel Combination of Harrington and Pedicular Screw Fixation in Traumatic Fracture-dislocation of Thoracic Spine: A Case Report and Literature Review

Background and Importance: Fracture-dislocation of the thoracic or lumbar spine (traumatic spondyloptosis) occurs in less than 5% of all spinal injuries mainly affecting the ventral direction. Case Presentation: A paraplegic young man was admitted to Shahid Kamyab Hospital in Mashhad City, Iran due to a motor vehicle accident. Computerized tomography (CT) showed a complete posterior dislocation of the T10 vertebral body on T9, with the superior articular processes of T9 bilaterally locked in the inferior endplate of T10 and complete fractures of the posterior elements. Conclusion: The spinal dislocation was re-aligned by a combination of Harrington fixation and pedicular screws leading to spinal fusion. Six months after surgery, the patient was still paraplegic but the sensory symptoms in the lower extremities and clean intermittent catheterization improved.

Clinical characteristics and treatment of fracture-dislocation of thoracic spine with or without minimal spinal cord injury.

It is important to evaluate clinical efficacy and safety of posterior internal fixation using pedicle screw system. To investigate clinical characteristics of patients diagnosed with fracture-dislocation of the thoracic spine with or without minimal spinal cord. Twenty-eight patients with fracture-dislocation of thoracic spine with or without minimal spinal cord injury were retrospectively analyzed. All patients received posterior reduction and internal fixation using pedicle screw system. The mean follow-up duration was 11.4months. Among 28 patients, 24 cases were complicated with bilateral pedicle or laminal fracture. Preoperatively, the percentage of vertebral displacement was (32.1 ± 20.6)%, significantly declined to (7.5 ± 6.0)% (t= 4.575, P= 0.001) and maintained at (7.9 ± 6.3)% at the final follow-up. Preoperative local kyphosis angle was measured as (16.2 ± 11.3)∘, restored to (15.4 ± 5.9)∘ postoperatively and (15.8 ± 5.4)∘ during the final follow-up. No statistical significance was observed at three time points (all P> 0.05). The remaining 25 patients were evaluated with normal and complete neurological function. No severe complications were observed intra- and postoperatively. Posterior internal fixation using pedicle screw is an efficacious and safe therapy which achieves proper reduction and preserves spinal cord function.

Transforaminal thoracic interbody fusion : Treatment of thoracic myelopathy caused by anterior compression.

The aim of this study was to evaluate the early clinical safety and efficacy of transforaminal thoracic interbody fusion(TTIF) with interbody cage application for thoracic myelopathy caused by anterior compression (TMAC). Atotal of 10patients who underwentTTIFfor TMAC from July 2009 to July 2014 were retrospectively reviewed. Thoracic spinal lesions included thoracic disc herniation, thoracic ossification ofposteriorlongitudinal ligament, thoracic vertebral compression fracture, and thoracic spine fracture dislocation. Demographic data, radiological findings as well as operative information were collected. Postoperative functional outcomes evaluated by the modified Japanese Orthopedic Association (mJOA) score and complications were analyzed. The mean operation time was 186.5 min (range 110-315 min), the mean operative blood loss was 845.0 ml (range 400-2000 ml), and the mean recumbent period was 2.7days (range 1-8days). During the follow-up period all patients exhibited significant improvements in neurological deficits. The mJOA score improved from amean of 6.1 ± 1.7 preoperatively to 7.4 ± 1.6 postoperatively and to 9.3 ± 1.6 at final follow-up (P<0.01), with an overall recovery rate of 69.0 ± 26.1%. Solid fusion was observed in all cases. Awound infection was found in one case, in which the patient recovered with no residual neurological deficits after surgical debridement and administration of intravenous antibiotics. No cage-related complications were found in this study. The use of TTIF with cage application can be an effective treatment method of thoracic myelopathy caused by anterior compression, with favorable efficacy and safety.

Effects of simple posterior decompression and fusion fixation as treatment strategy for complete thoracic fracture dislocation

Objective to investigate the clinical efficacy of decompression and pedicle screw fixation through posterior approach for complete thoracic spine fracture dislocation. Methods The clinical data of six patients with complete thoracic spine fracture and dislocation treated from September 2002 to June 2016 were analyzed retrospectively by case series study. There were five males and one female, aged 21-67 years old (mean, 47.2 years). The injury segments were T3~4 dislocation in one case, T5~6 dislocation in two cases, T6~7 dislocation in two cases and T8~9 dislocation in one case. There was one case of ASIA grade E and five cases of Grade A, and all of six cases were associated with multiple rib fractures and hemopneumothorax. The companied status was one case of sternal fracture, one case of atlantoaxial complex fractures and three cases of pulmonary contusion. The posterior median incision decompression and pedicle screw system fixation were performed, and the intervertebral bone grafting was conducted after restoration. The surgery time, bleeding volume during surgery, fracture restoration, bone grafting fusion, failure of internal fixation and other complications were recorded. The Visual Analogue Scale (VAS) and American Spinal Injury Association (ASIA) classification were used to assess the pain and neurological function improvement between the preoperative visit and final follow-up visit. Results The surgery time was 150-240 minutes (mean, 205 minutes). The bleeding volume during the surgery was 700-2 100 ml (mean, 1167 ml). One case was died of pulmonary infection at one week after surgery, the others were followed up for 3-14 months (mean, 7.4 months). After operation, five patients were satisfied with the reduction, and the lateral displacement was partially restored in one cases. Five cases of intervertebral bone grafting all had bone fusion. There was no fixation failure. The VAS was (7.4±0.6)points before surgery, (4.5±1.6)points at one week after surgery and (1.8±0.3)points at final visit of follow-up, which had significant difference from the preoperative status (P< 0.05). One case of ASIA grade E had no postoperative aggravation and four cases of grade A had no improvement. Conclusion Posterior decompression and pedicle screw fixation system is optimal choice of treatment for complete thoracic fractures and dislocations for it can attain reduction of fracture and dislocation as well as bone fusion, provide stability for spine and relieve pain. Key words: Spine fractures; Thoracic vertebrae; Fracture fixation, internal

Fracture-Dislocation of the Upper Thoracic Spine without Neurologic Associated Injury: Two Cases Report

Upper thoracic fractures are produced by high-energy trauma. Fracture-dislocation (type C Association) for the Study of Internal Fixation (AO classification) of the upper thoracic spine represents 15% of all thoracic and lumbar fractures. The neurological injury occurs in 80% of cases, being extremely rare type C fractures without spinal cord injury. We report a case of 51 years-old male with no past medical history, who was brought to our Hospital after falling from a 10 meters high roof. He had 15 points at Glasgow Coma Scale (GCS) and a completely normal neurological examination. A whole body computerized tomography (CT) scan was performed and diagnosed a fracture-dislocation at T8-T9. Acute surgery was decided, performing an open reduction and internal fixation with pedicle screws from T6 to T1. Clinical outcome was favorable. The second case is a 29 years old patient, who suffered a motorcycle accident. On arrival at critics room presented 14 points at GCS and American Spinal Injury Association scale (ASIA) E. After whole CT scan, was diagnosed a T10 fracture-dislocation, an open left iliac fracture, open right distal tibia fracture and a fracture of 10th left costal arch. Acute surgery was decided: performing external fixation of right tibia, wound cleaning and exploration of iliac crest and open reduction and fixation of the fracture-dislocation of thoracic spine. After nine days from the first surgery an open reduction and internal fixation (ORIF) of the right distal tibia was performed and a closed reduction and internal fixation (CRIF) of tibial plateau fracture. Ligamentoplasty of anterior cruciate ligament (ACL) of the right knee was also done arthroscopically. Clinical outcome was satisfactorily. The fracture-dislocation of the upper thoracic spine is often associated with spinal cord injury, there is a very few reported cases in bibliography without neurological damage. The initial clinical management of this patients is crucial at critics room, Advanced Trauma Life Support (ATLS) must be applied and subsequently perform a damage control. In patients with upper thoracic fracturedislocation without spinal cord involvement, immediate reduction and osteosynthesis should always be performed.

Late Occurrence of Traumatic Chylothorax in a Multi-Trauma Patient With a Thoracic Spine Fracture-Dislocation

Chylothorax is a rare form of chyle accumulation that can be associated with both traumatic and non-traumatic causes. We described a case of a patient who sustained a thoracic spine fracture-dislocation and presented with a left-sided chylothorax as a late complication to his thoracic spine trauma. A 19-year-old multi-trauma patient with bilateral pneumothorax, bilateral lung contusions and a severe thoracic spine fracture-dislocation was admitted to the intensive care unit (ICU) of our hospital intubated due to his unstable respiratory function. Bilateral thoracostomies were placed to his thoracic cavity prior to his admission to the ICU. The thoracic fracture-dislocation was stabilized with posterior fixation of his thoracic spine during his stay at the ICU. He was transferred to the neurosurgery department where at the 50th day of his hospitalization, a left-sided chylothorax was identified. Conservative management was decided and the chyle leak ceased over a period of 2 weeks. The patient was discharged from the clinic after a 3-month period of hospitalization. Traumatic chylothorax is a rare complication directly linked to thoracic spine fractures. It can occur immediately after trauma or several weeks after as in our case. Early diagnosis and treatment are essential for the avoidance of severe complications linked to the chyle loss. J Med Cases. 2015;6(12):568-571 doi: http://dx.doi.org/10.14740/jmc2364w

“Transforaminal Thoracic Interbody Fusion” in the Management of Lower Thoracic Spine Fracture Dislocations

A case-control clinical study. To assess the usefulness and safety of a novel reconstructive procedure known as transforaminal thoracic interbody fusion (TTIF) in the treatment of lower thoracic spine fracture dislocations, and to compare its efficacy with posterior/anterior combined surgery (PACS). We developed a TTIF procedure for thoracic spine lesions, and obtained good clinical outcomes for degenerative disorders of the thoracic spine. However, the technique of TTIF in the lower thoracic spine fracture dislocation has never been reported. Seven consecutive patients with lower thoracic spine fracture dislocations underwent TTIF (6 males, 1 female; mean age, 32 y), and 16 consecutive patients with lower thoracic spine fracture dislocations underwent PACS (14 males, 2 females; mean age, 37 y). Surgical complications, clinical outcomes, and sagittal alignment were investigated. Bony fusion was assessed using plain and functional x-rays and computed tomography scans. In the TTIF group and the PACS group, the mean operative times were 153 and 224 minutes, respectively, and the mean operative bleeding was 421 and 698 mL, respectively. All patients in the TTIF group were ambulatory within 2 days after surgery. Preoperative local sagittal alignments (kyphotic angles) were 22.9 and 22.5 degrees, respectively. Postoperative local sagittal alignments were 9.9 and 7.2 degrees, respectively. There were no instances of instrumentation failure or nonunion, and there were no serious complications such as neurological deficits in either group. In addition, a chest tube was necessary in 11 cases (69%) of PACS after thoracotomy, but was not required in any TTIF cases. TTIF achieves posterior rigid fixation with instrumentation, and anterior column reconstruction by interbody fusion. This procedure also enables early postoperative ambulation without respiratory problems. TTIF can be a useful option for reconstructive surgery of the lower thoracic spine after fracture dislocations.

Treatment of subacute thoracic spine fracture-dislocation by total vertebrectomy and spine shortening

Vertebral resection with spine shortening has been primarily reported for the treatment of demanding cases of nontraumatic disorders. Recently, this technique has been applied to the treatment of traumatic disorders. The current treatment of vertebral fracture-dislocation when there is partial or total telescoping of the involved vertebrae is a combined anterior-posterior approach with corpectomy, anterior support implant, and further posterior instrumentation. These procedures usually require 2 surgical teams, involve longer operating times and greater risk of surgical complications related to the anterior approach, and commonly entail longer postoperative care before discharge. The authors report on 2 patients with high thoracic fracture-dislocations with telescoping (T-2 and T-4) who were treated in the subacute phase with total spondylectomy (T-3 and T-5, respectively) and spine shortening by using only a posterior approach. Complete recovery of the sagittal balance was achieved with this technique and the postoperative periods were clinically uneventful. One patient presented with asymptomatic hemothorax that did not require drainage. In paraplegic patients with anterior thoracic dislocation fractures in which one vertebral body blocks the reduction of the other, total spondylectomy and spine shortening seem to be a reasonably safe and effective technique.

Total Vertebrectomy and Spine Shortening in the Management of Acute Thoracic Spine Fracture Dislocation

Case report of 3 thoracic spine fracture-dislocations with complete spinal cord section treated by total vertebrectomy--spine shortening through a posterior approach. To assess the usefulness and safety of this surgical technique in the treatment of acute thoracic spine fracture-dislocation. Total vertebrectomy can be used in different nontraumatic disorders. This surgical procedure has been used in the chronic phase of traumatic thoracolumbar dislocation. To our knowledge, the technique of total vertebrectomy and spine shortening in the acute phase of thoracic spine fracture dislocation has never been reported. Three patients who suffered thoracic spine fracture-dislocation with ASIA A paraplegia underwent complete vertebrectomy and spine shortening through a posterior approach. We report technical details, clinical, and radiologic results at 24 months minimum follow-up. Complete vertebrectomy of the fractured vertebra involved T5 in 1 patient, T7 in another, and T10 in the third. There were no perioperative complications. At latest follow-up, fusion was obtained in all 3. Overall sagittal and coronal alignment was restored. Complete vertebrectomy and spinal shortening can be used in the acute phase to manage thoracic spine fracture-dislocations.

Two reduction cases of thoracic spine fracture dislocation by partial vertebral body excision

Two reduction cases of thoracic spine fracture dislocation by partial vertebral body excision

Case report of complete dislocation of T1–T2 without neurological deficit and review of the literature

Fracture-dislocations of the thoracic spine comprise about 16% of all thoracic and lumbar fractures, and are commonly caused by high-speed road accidents. Unlike the cervical spine, the thoracic spine is stabilized by its connection to the rib cage by transverse costal ligaments. The position of the articular facets provides resistance to axial rotation and horizontal translation. Therefore, a severe injury is required to bring about a fracture-dislocation at this level. These injuries, due to the narrowness of the thoracic canal and the precarious blood supply of the cord, lead to complete paraplegia in more than 80% of cases. Thoracic spine fracture-dislocations that are not accompanied by neurological damage are extremely rare, and only a few cases are described in the literature. We present here a case of complete posterior dislocation of the first thoracic vertebra over the second without neurological damage, and we discuss its surgical treatment.

Early Experiences With Video-Assisted Thoracoscopic Surgery: Our First 70 Cases

Prospective consecutive series. Analysis of the results and outcomes of patients treated with video-assisted thoracoscopic surgery for spinal pathology. Video-assisted thoracoscopic surgery is an alternative to open thoracotomy. It has been suggested that the learning curve is substantial. The authors present their early experience in treating a variety of spinal pathologies with this technique. Seventy cases were available at the 2-year follow-up. Video-assisted thoracoscopic surgery with the goal of anterior spinal release and fusion was carried out on patients with the following diagnoses: idiopathic scoliosis, neuromuscular spinal deformity, Scheuermann kyphosis, congenital and infantile scoliosis, neurofibromatosis, Marfan syndrome, postradiation scoliosis, and repair of pseudarthrosis. Three patients had excision of the first rib to treat thoracic outlet syndrome. Two patients had excision of intrathoracic neurofibroma and a benign rib tumor. One had anterior fusion following thoracic spine fracture-dislocation. The average operative time for the thoracoscopic anterior release with discectomy and fusion procedure was 256 minutes (range 150-405 minutes). The average number of discs excised was 8 (range 4-11 discs). The average operative time per disc was 32.5 minutes (range 20-45 minutes). The average blood loss during the thoracoscopic anterior release with diskectomy and fusion was 285 mL (range 150-405 mL). Final postoperative scoliosis and kyphosis corrections were 68% (range 41-91%) and 90% (range 47-100%), respectively. Complications related to thoracoscopy occurred in 3 patients. All deformity patients had evidence of anterior fusion radiographically. Video-assisted thoracoscopic surgery provides a safe and effective alternative to open thoracotomy in the treatment of thoracic pediatric spinal deformities. The procedure remains time consuming.

Chest wall trauma.

Sufficient trauma to the chest can result in injury to the bony thorax and soft tissues of the chest wall, increasing patient morbidity and mortality. Fractured ribs can lacerate the pleura, lung, or abdominal organs. Fractures to upper ribs, clavicle, and upper sternum can signal brachial plexus or vascular injury. Paradoxical movement of a flail chest can impair respiratory mechanics, promote atelectasis, and impair pulmonary drainage. Most patients with thoracic spine fracture-dislocations have complete neurologic deficits. Scapular fractures, associated with other injuries in almost all patients, are frequently overlooked on supine chest radiographs. Sternal fractures, associated with clinically silent myocardial contusion, are best visualized on chest computed tomography (CT). Severe trauma to the chest wall can be associated with large chest wall hematomas or collections of air within the chest wall that can communicate with the intrathoracic space. CT scanning can easily distinguish chest wall from parenchymal or mediastinal injury, whereas this differentiation my not be possible with chest radiography.