Abstract

Introduction: Multilevel noncontiguous thoracic spine fractures are usually due to high-energy trauma and often associated with life threatening organ injuries or neurological deficits. Early posterior percutaneous fixation has shown its efficacy in non-neurologic fractures and for comorbidity management. However, it remains a tricky procedure due to spine instability and anatomic landmark modification. Additional intraoperative CT-assisted navigation might improve precision in such long and complex spine fixation.

Case Presentation: A 26-year old men was admitted to ICU after a very high velocity motorcycle accident at 250km/h. Surprisingly, he had no neurological deficits, but the initial traumatic assessment revealed triple unstable noncontiguous thoracic spine fractures of Th4, Th6 and Th8. The patient was treated with a hybrid minimal invasive approach using an intraoperative 3D CT-scan navigation system and percutaneous pedicle-screwing method. The postoperative CT-Scan shown instrumentation from Th2 to Th10 and demonstrated correction of regional kyphosis. The patient regained his mobility and started to walk 3 days following the surgery. He was discharged with temporary additional thoraco-lumbar corset 7 days after surgery without any postoperative complications.

Discussion: Navigated trans-pedicular screw fixation has proven its superiority in precision. The use of live intraoperative CT-scan with spinous process reference marker provides critical information about spine alignment and pedicular trajectories which facilitate screw placement in fractured or misplaced vertebrae. The addition of standard lateral C-arm can be easily implemented.

Conclusion: Noncontiguous triple fractures of the thoracic spine are an unusual presentation of polytrauma injury. Long and complex thoracic posterior spine fixation is feasible in a safe way using an intraoperative CT-navigated minimal invasive technique in support.

Keywords: Noncontiguous spine fractures; Thoracic spine fixation; Minimal invasive technique; Intraoperative CT-scan navigation

Abbreviations: CT: Computed Tomography; ISS: Injury Severity Score; ICU: Intensive Care Unit; ASIA: American Spinal Injury Association; MRI: Magnetic Resonance Imaging; AO-Spine: Arbeit gemeinschaft für Osteo-synthesefragen Spine.