Fracture-dislocation of the thoracic spine without neurological lesion.

On 26 February, a 32-year-old man was involved in an automobile accident. He was taken to a local hospital where radiographs showed a fracture-dislocation of the thoracic spine. He was transferred by ambulance to our hospital. On admission the patient was alert, complaining of severe pain in the chest and breathing difficulty. Examination revealed a tender thoracic spine with deformity. There were pain and crepitation over the 6th and 8th right ribs, 8th and 9th left ribs and left scapula. Neurologically, cranial nerves, reflexes, sphincter tone, motor power and sensory examination were normal. Radiological examination and biplanar tomograms revealed a shear fracture of the 9th thoracic vertebra and a burst fracture of the 8th thoracic vertebra with a lateral and vertical dislocation of the 8th thoracic vertebra on the 9th thoracic vertebra (Figure I), a 41” dorsal kyphotic angle at the 8th thoracic vertebra (Figures), left scapular body fracture, 6th and 8th right rib fractures and 8th and 9th left rib fractures. A CT showed a fracture of the T8 and T9 bodies with a disruption of the right pedicle-body continuity at T8, without significant narrowing of the neural canal (Figure 3). He was kept on bed rest for 10 days before surgical stabilization. An anterior retropleural strut-graft from T7 to TlO with a rib and iliac cancellous graft was performed. He had an uneventful postoperative course and was fitted with a cast that he wore continuously while he was on bed rest. He left hospital 2 weeks after the operation. At 2 months the cast was removed, he was placed in a plastic body jacket and allowed to walk. The body jacket was taken off 5 months later. In the last assessment, 3 years after the operation, he was completely asymptomatic, with a pain-free full range of movement of his back. Radiographs showed an excellent fusion mass (Fgctre 4).