Dichotomous Profile of Thoraco-lumbar Dislocation Fractures. Case Report and Review of the Literature

Abstract

Abstract Background. Dislocated thoracolumbar fractures are rare injuries following major trauma. However, the resulting spinal cord injuries do not always correspond to the radiological characteristics of osteo-disco-ligamentary injuries. We report a case of thoracolumbar dislocated fracture of which radiological finding was in discrepancy with clinical aspect and postoperative evolution according to spinal cord injury. Case presentation. A 32-year-old congolese female admitted in Neurosurgery Department of the University Hospital of Kinshasa for low back pain and functional impotence of lower limbs and urinary retention following a road traffic accident three weeks prior. The physical examination was normal. We found a painful swelling at level of T12-L2 spinous processes and Wagner's grade IV gluteal pressure sores. Neurologically, the sensation was preserved on both limbs, motor strength on lower limbs was graded 3/5 globally. She had urinary retention. We made a diagnosis of an incomplete spinal cord injury (ASIA C) secondary to a thoraco-lumbar spinal trauma. CT-Scan showed a fracture of the vertebral body and pedicles of L2 with retrolisthesis of L1/L2 grade IV (Magerl B.3.3). She underwent posterior spinal decompression followed by spinal stabilisation with pedicle screws. The gluteal ulcers were debrided and sutured during the same surgery. Postoperatively, the pressure ulcers healed and the patient recovered full motor and urinary sphincter functions after several sessions of physiotherapy months. Conclusion. This case report demonstrates the possibility of discordance between radiological images of dislocated thoracolumbar fractures and spinal cord injury clinical.