Rahimizadeh Abolfazl, Asgari Naser, Rahimizadeh Ava
a Department of Neurosurgery, Pars Advanced and Minimally Invasive Medical Manners Research Center , Pars Hospital, Iran University of Medical Science , Tehran , Iran.
b R&D Committee, Pars Advanced and Minimally Invasive Medical Manners Research Center , Pars Hospital, Iran University of Medical Science , Tehran , Iran.
J Spinal Cord Med. 2018 May;41(3):367-376. doi: 10.1080/10790268.2017.1336300. Epub 2017 Jun 26.
The thoracolumbar junction from T11 to L2 is a common site of injury in which fracture and dislocations are the most prevalent ones occurring at this location. Fracture dislocation is defined as failure of all three columns of the spine with gross displacement. Considering the significant violence necessary to produce fracture dislocations, these injuries are often associated with major neural deficit, with the majority of casualties becoming paraplegic immediately. Preservation of neurological function following complete fracture dislocation is quite rare entity.
To represent the possibility of existence of a preservation mechanism for functional integrity of cord despite spinal gross fracture dislocation by reproducing the injury on a plastic model and simulating a corresponding model using 3DSlicer software, detailed description the pathomechanism of neurologic sparing.
A 19-year-old female who sustained severe thoracolumbar fracture dislocation but with normal neurology is presented. Despite the severity of the condition, the diagnosis was initially missed due to associated vital injuries.
Combined posterior and anterior surgery resulted in optimal coronal and sagittal alignment, as well as proper stabilization without any complication. At 9-year follow-up, the patient was found to be doing well.
The prognosis for complete recovery with preplanned surgical intervention in thoracolumbar injuries affecting all three columns but with normal neurologic function is promising based on images, plastic models and 3D simulated model based on digital images.
胸腰段交界区（T11至L2）是常见的损伤部位，骨折和脱位是该部位最常见的损伤类型。骨折脱位定义为脊柱三柱均受损且伴有明显移位。鉴于产生骨折脱位需要巨大暴力，这些损伤常伴有严重神经功能缺损，大多数伤者会立即出现截瘫。完全骨折脱位后神经功能得以保留的情况极为罕见。
通过在塑料模型上重现损伤并使用3DSlicer软件模拟相应模型，展现尽管存在脊柱严重骨折脱位但脊髓功能完整性仍有保留机制的可能性，详细描述神经功能保留的病理机制。
介绍一名19岁女性，她遭受了严重的胸腰段骨折脱位，但神经功能正常。尽管病情严重，但由于合并有危及生命的损伤，最初漏诊了该病例。
前后联合手术实现了最佳的冠状面和矢状面复位以及恰当的固定，且无任何并发症。随访9年时，发现患者情况良好。
基于影像学、塑料模型以及基于数字图像的3D模拟模型，对于累及脊柱三柱但神经功能正常的胸腰段损伤，通过预先规划的手术干预实现完全康复的预后前景良好。
