Floating Thoracic Spine After Double, Noncontiguous Three-Column Spinal Fractures

• Published in: World neurosurgery 2016-07, Vol.91, p.670.e7-670.e11
• Main Authors: Salehani, Arsalaan A., Baum, Griffin R., Howard, Brian M., Holland, Christopher M., Ahmad, Faiz U.
• Format: Article
• Language: English
• Subjects: Fracture dislocation; Humans; Male; Middle Aged; Orthopedics - methods; Spinal Fractures - diagnostic imaging; Spinal Fractures - etiology; Spinal Fractures - surgery; Spinal Fusion - methods; Spinal Injuries - complications; Spinal Injuries - diagnostic imaging; Spine trauma; Thoracic fracture; Thoracic Vertebrae - diagnostic imaging; Thoracic Vertebrae - pathology; Thoracic Vertebrae - surgery; Three-column injury; Tomography Scanners, X-Ray Computed
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.03.082

Double, noncontiguous, 3-column spinal injuries are a rare phenomenon most often caused by high-energy trauma. The resulting multilevel, fracture-dislocation injuries represent 2 separate 3-column lesions and produce a floating spine segment between the 2 fracture dislocation sites. Only a few cases of these rare, posttraumatic injuries have been reported previously; however, all of these included a combination of injuries in the cervical, thoracic, lumbar, and/or sacral spine. We present the first report of a case of double-level spinal injury isolated to the thoracic spine, with an intermediate floating spinal segment in a 48-year-old man after a 30-foot fall. In our case, the standard 3 above and 2 below pedicle instrumentation was not sufficient to stabilize the thoracic spine. We consider the evaluation and surgical management of these fractures and discuss how a standard “3 above-2 below” approach may not be sufficient to stabilize these unstable injuries. In the case of severe, noncontiguous double chance fractures of the spine, we recommend a more extensive anteroposterior approach to reduce the risk of hardware failure and worsening spinal deformity.