Department of Orthopaedic Surgery, Seoul Spine Institute, Sanggyepaik Hospital, College of Medicine, Inje University, Seoul, Korea.
Medicine (Baltimore). 2021 Jan 15;100(2):e24096. doi: 10.1097/MD.0000000000024096.
We report the first case of the management of spinal cord transection due to thoracolumbar fracture-dislocation in human beings. There are several case reports of cord transection, but only radiological findings have been reported; we report intraoperative findings and management.
A 53-year-old man presented to the hospital after falling. He had no motor power or sensation below T10 (below the umbilicus area) dermatome level. American Spinal Injury Association (ASIA) impairment scale was grade A. Magnetic resonance imaging and computed tomography demonstrated a fracture and translation of the vertebral body at the T11-T12 level and anterior displacement of T11 on T12, with complete disruption of the spinal cord.
Complete spinal cord resection due to T11-T12 fracture-dislocation.
We performed spinal fusion with pedicle screw instrumentation (T10-L1) and autobone graft and decompression and repaired the dural sac to prevent cerebrospinal fluid leakage. There was no neurological recovery either immediately or 4 years post-operation at follow-up.
To the best of our knowledge, this report is the first on the intraoperative finding and management of the complete transection of the spinal cord in thoracolumbar spine injury. Perfect fusion is required to facilitate rehabilitation and daily living, prevent neurogenesis, and prevent unnecessary pain such as phantom pain.
我们报告首例胸腰椎骨折脱位导致脊髓横断的治疗病例。已有数例脊髓横断的病例报告，但仅报道了影像学发现；我们报告了术中发现和处理方法。
一名 53 岁男性从高处坠落后来院就诊。他的 T10（脐区以下）以下感觉和运动功能完全丧失。美国脊髓损伤协会（ASIA）损伤分级为 A 级。磁共振成像和计算机断层扫描显示 T11-T12 椎体骨折和移位，T11 向前移位至 T12，脊髓完全断裂。
T11-T12 骨折脱位导致完全性脊髓切断。
我们行 T10-L1 经皮椎弓根螺钉内固定融合术，自体骨移植，行减压和硬脊膜修补以防止脑脊液漏。术后即刻和 4 年随访时均无神经恢复。
据我们所知，这是首例胸腰椎脊柱损伤完全性脊髓横断的术中发现和处理报告。需要进行完善的融合以促进康复和日常生活，防止神经发生和不必要的疼痛，如幻痛。
