Fracture-Dislocation of the Thoracic Spine without Any Neurological Deficit: A Case Report and Review of the Literature

Introduction: Thoracic spinal fracture dislocation injury usually is caused by a high-energy trauma.Therefore, this kind of injury should always be suspected in the patients who have sustained a multipletrauma. The thoracic spinal fracture-dislocation is commonly accompanied by neurological symptoms. Inthe literature, only few cases are reported who did not present neurological symptoms.Case presentation: A 25-year-old man was brought to our emergency department following a vigorousmotor-vehicle accident, complaining from excruciating pain in his right shoulder. The promptly obtainedradiographs revealed right shoulder fracture dislocation that was reduced through intervenus sedation, inthe emergency department. The overt shoulder injury distracted the ER physician’s attention from thevertebral translation, visualized in the initial chest radiographs. Secondary survey, obtained on the nextday, revealed a serious T5-T6 fracture-dislocation and absence of neurological deficit. The computedtomography and magnetic resonance imaging provided the details of the spinal injury. Open reductionand stabilization was performed by application of the rods and pedicle screws. The neurologic conditionremained intact postoperatively. A CTLSO brace was administrated to wear whenever he was walking orsitting. The brace was weaned off at the 24th week when he started physical exercises.Conclusions: In a small number of patients who suffered spinal fracture-dislocation, the radiographicfeature or severity does not correlate with the clinical manifestation. The treatment strategy is tailoredindividually, i.e., open reduction and internal fixation is advised whenever surgical intervention isindicated.

Keywords:

Dislocation , Fracture , Thoracic vertebrae , Neurological deficit