Traumatic expulsion of T4 vertebral body into the spinal canal treated by vertebrectomy and spine shortening.

STUDY

DESIGN

A case report.

OBJECTIVE

To describe an exceptional case of traumatic 2-level adjacent disk disruption with expulsion of the vertebral body into the spinal canal treated by vertebrectomy and spine shortening.

SUMMARY OF BACKGROUND DATA: Traumatic spondyloptosis is a very rare injury caused by high-energy trauma. Vertebral body expulsion is mostly the result of tremendous flexion-extension shearing forces causing a double contiguous disk disruption.

METHODS

A 49-year-old male was admitted to the emergency department of another hospital because of a high-speed car crash. He was conscious and collaborating and showed a complete paraplegia. Spinal computed tomographic scan showed a posterior expulsion of the T4 vertebral body and dislocation into the spinal canal. Magnetic resonance imaging of the spine confirmed the presence of a 2-level adjacent T3-T4 and T4-T5 disk disruption and severe compression of the spinal cord by the T4 vertebral body. We performed a posterior stabilization from T1 to T8 with T4 vertebrectomy and spine shortening.

RESULTS

A postoperative computed tomographic scan showed a tolerable sagittal and frontal alignment and apposition of the endplates of T3 and T5. At present, 12 months after surgery, the patient is neurologically unchanged, but he can keep the sitting position without support.

CONCLUSION

Total vertebrectomy and spinal shortening are safe and replicable procedures applicable in few patients with paraplegia. A surgical procedure after 3 weeks makes a complete reduction and a perfect sagittal alignment of the spine difficult to be obtained.