Fig. 13.1 Initial findings of an injury of the thoracolumbar junction treated at another clinic (misinterpretation as a stable T12 compression fracture (A Type injury/AOSpine Classification)
Fig. 13.2 Recent CT examination due to increasing pain and malalignment (approx. 40°). Actual injury: unstable T11/T12 flexion-distraction injury with T12 burst fracture with rupture of the posterior ligaments (B Type injury/AOSpine Classification)
Fig. 13.3 Spine surgery with vertebral fracture replacement implant, screws and bars (front view)
Fig. 13.4 Surgical outcome after combined dorsoventral stabilisation (view from the side)
This case of a 30-year-old patient shows how important follow-up checks are in the case of supposedly harmless vertebral fractures.
The young woman was a passenger on the motorcycle of her friend that crashed while driving through a curved part of the road. She is thrown through the air and has injured her back on impact. Using initial x-ray images of the spine, a fracture of the eleventh thoracic vertebra (Fig. 13.1) is diagnosed. The patient receives painkillers and notification that no further follow-up check is necessary.
Three months have elapsed since the accident. The patient’s pain has increased despite taking medication, and she also cannot stand up without experiencing pain. Her back has now taken on an atypical hump-like shape.
Recent CT examination of the thoracic and lumbar spine now shows that the injury is actually an incomplete burst fracture with rupture of the ligaments. A marked increase in the original malalignment with a large distance between the ends of the spinal processes can be seen. This is the typical sign of a distraction injury with instability due to rupture of the dorsal ligaments (Type B/AOSpine classification) (Fig. 13.2). The actual severity of injury is therefore higher than originally assumed and would have required immediate surgical treatment after the accident. The delayed surgery to correct the post-traumatic dislocation is now a more elaborate procedure, but still possible as shown in Fig. 13.3 and Fig. 13.4.
Special case injuries associated with Bechterew’s disease / Forestier’s disease or diffuse idiopathic skeletal hyperostosis (DISH) syndrome