A multilevel noncontiguous spinal fracture with cervical and thoracic spinal cord injury

Abstract

Introduction and importance: A multi-level non-contiguous spinal fracture (MNSF) caused by a high-energy impact is a type of complex traumatic injury that is been frequently initially missed, and resulting in delayed diagnosis which adversely affects can result in spinal deformity and neurological deficit. This report describes the operative management of a patient with MNSF with spinal cord injury involving the cervical and thoracic vertebrae by cervical orthosis and posterior thoracic decompression and fusion. Case presentation: An 18-year-old male presented with extensive neck pain and paraplegia (ASIA A), following a motor vehicle accident. Radiographic imaging revealed MNSF: a non-displaced spinous process fracture of C5 (AO Spine subaxial cervical injury classification A0) with spinal cord injury combined with fracture-dislocation of T5 to T9 (AO Spine thoracolumbar injury classification C3). Posterior thoracic decompression and fusion was performed at T3 to T8. After the patient underwent the thoracic spine and cervical orthosis treatment, He received rehabilitation program and training transfer with wheelchair without caregiver. His sitting and balance were significantly improved at the 6 months follow-up. Although the lower extremity functions (ASIA A) may not improve due to the severe spinal cord injury. Clinical discussion: MNSF with spinal cord injury following a high-velocity accident is an unstable and complex injury. Important of the clinical assessment and according to the injuries the treatment may vary. Conclusions: Cervical orthosis was alternative treatment to preserve cervical motion treatment and posterior thoracic decompression with fixation is an effective option for patients in this MNSF with spinal cord injury.