Floating Spine and Other Types of Associated Multiple Simultaneous Unstable Spinal Fractures
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Published:
Jun 17, 2023
Keywords:
multiple vertebral fractures, floating spine, trauma, high energy, unstables fractures
Main Article Content
Abstract
Introduction: We intend to present a series of patients with associated multiple and simultaneous unstable spinal fractures (Type B or C).
Materials and Methods: A descriptive analysis of patients with high-energy spinal cord injuries and associated multiple unstable and simultaneous spinal fractures from January 2015 to January 2021 was conducted. Patients with type B (ligament injury) and/or type C (subluxation/dislocation) multiple spinal fractures were included. Patients with incomplete medical records, osteoporotic or pathological fractures, or fewer than 3 months of follow-up were excluded.
Results: We included 5 patients (1 woman and 4 men) with two simultaneous unstable spinal fractures, including 4 cases (80%) of non-contiguous fractures and 3 (60%) with two simultaneous non-contiguous fracture dislocations (“floating spine”); 2 (40%) cases had a type B fracture associated with a type C fracture. The median age was 35 years. High-energy trauma with associated injuries occurred in all cases. All patientswere surgically treated with a conventional posterior approach, reduction, and long arthrodesis. In two patients, neurological recovery was confirmed.
Conclusion: A case series of multiple simultaneous unstable spinal fractures (type B or C) caused by high-energy trauma is presented. This is a rare injury association with significant morbidity associated with spinal, systemic, and neurological trauma.
Materials and Methods: A descriptive analysis of patients with high-energy spinal cord injuries and associated multiple unstable and simultaneous spinal fractures from January 2015 to January 2021 was conducted. Patients with type B (ligament injury) and/or type C (subluxation/dislocation) multiple spinal fractures were included. Patients with incomplete medical records, osteoporotic or pathological fractures, or fewer than 3 months of follow-up were excluded.
Results: We included 5 patients (1 woman and 4 men) with two simultaneous unstable spinal fractures, including 4 cases (80%) of non-contiguous fractures and 3 (60%) with two simultaneous non-contiguous fracture dislocations (“floating spine”); 2 (40%) cases had a type B fracture associated with a type C fracture. The median age was 35 years. High-energy trauma with associated injuries occurred in all cases. All patientswere surgically treated with a conventional posterior approach, reduction, and long arthrodesis. In two patients, neurological recovery was confirmed.
Conclusion: A case series of multiple simultaneous unstable spinal fractures (type B or C) caused by high-energy trauma is presented. This is a rare injury association with significant morbidity associated with spinal, systemic, and neurological trauma.
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How to Cite
Ricciardi, G. A., Romero Valverde, L. J., Formaggin, S., Garfinkel, I., Carrioli, G., & Ricciardi, D. O. (2023). Floating Spine and Other Types of Associated Multiple Simultaneous Unstable Spinal Fractures. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 88(3), 321-330. https://doi.org/10.15417/issn.1852-7434.2023.88.3.1652
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Clinical Research
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19. Seçer M, Alagöz F, Uçkun O, Karakoyun OD, Ulutaş MÖ, Polat Ö, et al. Multilevel noncontiguous spinal fractures: Surgical approach towards clinical characteristics. Asian Spine J 2015;9(6):889-94. https://doi.org/10.4184/asj.2015.9.6.889
20. Iencean SM. Double noncontiguous cervical spinal injuries. Act Neurochir (Wien) 2002;144(7):695-701.
https://doi.org/10.1007/s00701-002-0940-7
21. Calenoff L, Chessare JW, Rogers LF, Toerge J, Rosen JS. Multiple level spinal injuries: importance of early
recognition. AJR Am J Roentgenol 1978;130(4):665-9. https://doi.org/10.2214/ajr.130.4.665
22. Bazán PL, Avero González RA, Patalano L, Borri ÁE, Medina M, Cortés Luengo C, et al. Fracturas vertebrales
múltiples. Rev Asoc Argent Ortop Traumatol 2022;87(1):51-6. https://doi.org/10.15417/issn.1852-7434.2022.87.1.1407
23. Szabó V, Nagy M, Büki A, Schwarcz A. Percutaneous spine fusion combined with whole-body traction in the acute surgical treatment of AO A- and C-type fractures: A technical note. World Neurosurg 2022;159:13-26.
https://doi.org/10.1016/j.wneu.2021.12.032
1969;1(5492):891-4. https://doi.org/10.1136/bmj.1.5492.891
2. Tearse DS, Keene JS, Drummond DS. Management of non-contiguous vertebral fractures. Paraplegia
1987;25(2):100-5. https://doi.org/10.1038/sc.1987.18
3. Gupta A, el Masri WS. Multilevel spinal injuries. Incidence, distribution and neurological patterns. J Bone Joint
Surg Br 1989;71(4):692-5. https://doi.org/10.1302/0301-620X.71B4.2768324
4. Keenen TL, Antony J, Benson DR. Non-contiguous spinal fractures. J Trauma 1990;30(4):489-91. PMID: 2325181
5. Kanna RM, Gaike CV, Mahesh A, Shetty AP, Rajasekaran S. Multilevel non-contiguous spinal injuries: incidence
and patterns based on whole spine MRI. Eur Spine J 2016;25(4):1163-9. https://doi.org/10.1007/s00586-015-4209-2
6. Green RA, Saifuddin A. Whole spine MRI in the assessment of acute vertebral body trauma. Skeletal Radiol
2004;33(3):129-35. https://doi.org/10.1007/s00256-003-0725-y
7. Takami M, Okada M, Enyo Y, Iwasaki H, Yamada H, Yoshida M. Noncontiguous double-level unstable spinal
injuries. Eur J Orthop Surg Traumatol 2017;27(1):79-86. https://doi.org/10.1007/s00590-016-1855-y
8. Pellise F, Bago J, Villanueva C. Double-level spinal injury resulting in “en bloc” dislocation of the lumbar spine. A
case report. Acta Orthop Belg 1992;58(3):349-52. PMID: 1441976
9. Cho SK, Lenke LG, Hanson D. Traumatic noncontiguous double fracture-dislocation of the lumbosacral spine.
Spine J 2006;6(5):534-8. https://doi.org/10.1016/j.spinee.2006.01.015
10. Waitt T, Reddy V, Grogan D, Lane P, Kilianski J, DeVine J, et al. A case of dual three-column thoracic spinal
fractures following traumatic injury. Surg Neurol Int 2020;11:150. https://doi.org/10.25259/SNI_189_2020
11. Salehani AA, Baum GR, Howard BM, Holland CM, Ahmad FU. Floating thoracic spine after double, noncontiguous three-column spinal fractures. World Neurosurg 2016;91:670.e7-670.e11. https://doi.org/10.1016/j.wneu.2016.03.082
12. Vaccaro AR, Oner C, Kepler CK, Dvorak M, Schnake K, Bellabarba C, et al. AOSpine thoracolumbar spine
injury classification system: fracture description, neurological status, and key modifiers. Spine (Phila Pa 1976)
2013;38(23):2028-37. https://doi.org/10.1097/BRS.0b013e3182a8a381
13. ASIA and ISCoS International Standards Committee. The 2019 revision of the International Standards for
Neurological Classification of Spinal Cord Injury (ISNCSCI)-What’s new? Spinal Cord 2019;57(10):815-7.
https://doi.org/10.1038/s41393-019-0350-9
14. Granger CV, Hamilton BB, Linacre JM, Heinemann AW, Wright BD. Performance profiles of the functional
independence measure. Am J Phys Med Rehabil 1993;72(2):84-9. https://doi.org/10.1097/00002060-199304000-00005
15. Lian XF, Zhao J, Hou TS, Yuan JD, Jin GY, Li ZH. The treatment for multilevel noncontiguous spinal fractures. Int
Orthop 2007;31(5):647-52. https://doi.org/10.1007/s00264-006-0241-5
16. Miller CP, Brubacher JW, Biswas D, Lawrence BD, Peter G, Whang PG, et al. The incidence of noncontiguous
spinal fractures and other traumatic injuries associated with cervical spine fractures: a 10-year experience at an
academic medical center. Spine (Phila PA 1976) 2011;36(19):1532-40. https://doi.org/10.1097/BRS.0b013e3181f550a6
17. Nelson DW, Martin MJ, Martin ND, Beekley A. Evaluation of the risk of noncontiguous fractures of the spine in
blunt trauma. J Trauma Acute Care Surg 2013;75(1):135-9. https://doi.org/10.1097/ta.0b013e3182984a08
18. Sarotto AJ, Astiasarán JP, Steverlynck A, Muscia R, Castelli R, Melo LM, et al. High energy spine injury alternate
multiple fractures. Observational retrospective study. SN Compr Clin Med 2020;2:75-81. https://doi.org/10.1007/s42399-019-00212-z
19. Seçer M, Alagöz F, Uçkun O, Karakoyun OD, Ulutaş MÖ, Polat Ö, et al. Multilevel noncontiguous spinal fractures: Surgical approach towards clinical characteristics. Asian Spine J 2015;9(6):889-94. https://doi.org/10.4184/asj.2015.9.6.889
20. Iencean SM. Double noncontiguous cervical spinal injuries. Act Neurochir (Wien) 2002;144(7):695-701.
https://doi.org/10.1007/s00701-002-0940-7
21. Calenoff L, Chessare JW, Rogers LF, Toerge J, Rosen JS. Multiple level spinal injuries: importance of early
recognition. AJR Am J Roentgenol 1978;130(4):665-9. https://doi.org/10.2214/ajr.130.4.665
22. Bazán PL, Avero González RA, Patalano L, Borri ÁE, Medina M, Cortés Luengo C, et al. Fracturas vertebrales
múltiples. Rev Asoc Argent Ortop Traumatol 2022;87(1):51-6. https://doi.org/10.15417/issn.1852-7434.2022.87.1.1407
23. Szabó V, Nagy M, Büki A, Schwarcz A. Percutaneous spine fusion combined with whole-body traction in the acute surgical treatment of AO A- and C-type fractures: A technical note. World Neurosurg 2022;159:13-26.
https://doi.org/10.1016/j.wneu.2021.12.032