Translation-rotation thoracic spine injury

Case contributed by Dr Dalia Ibrahim

Presentation

Motor car accident.

Patient Data

Age: 30 years
Gender: Male

The hallmark of the examination is the presence of translation-rotation fractures involving T8 and T9 vertebrae evident by:

  • T8-9 unilateral left facet joint perching with subsequent vertebral slippage of T8 over T9 vertebrae and a small retropulsed bone fragment detached from the posterior inferior aspect of T8
  • secondary comminuted wedge fracture of T9 vertebra, associated with bilateral pars fractures of T9
  • fractures of T8 and T9 spinous processes

Fractures of the left 4-6th 8th and 10th rib heads at their vertebral attachments.

Fracture of the left transverse process of T5, T7, T10 and T11 vertebrae and the left superior articular process of T11 and right superior articular process of T12.

N.B: Bilateral marked pleural effusions (hemothoraces) with underlying collapse.

The hallmark of the examination is the presence of translation-rotation fractures involving T8 & T9 vertebrae evident by:

  • T8-9 unilateral left facet joint perching with subsequent vertebral slippage of T8 over T9 vertebrae and a small retropulsed bone fragment detached from the posterior inferior aspect of T8
  • secondary comminuted wedge fracture of T9 vertebra, associated with bilateral pars fractures of T9
  • fractures of T8 & T9 spinous processes.
  • torn ligamenta flavum, interspinous, supraspinous ligaments, being replaced by edema signal

The spinal cord opposite T8 and T9 level show abnormal high T1&T2 intramedullary signal, representing cord contusion.

T8-9 central posterior disc protrusion indenting the theca.

Fractures of the left 4th, 5th, 6th 8th and 10th rib heads at their vertebral attachments.

Fracture of the left transverse process of T5, T7, T10 and T11 vertebrae and the left superior articular process of T11 and right superior articular process of T12.

N.B: Bilateral marked pleural effusions (hemothoraces) with underlying collapse.

Annotated image

T8-9 unilateral left facet joint perching (circles).

vertebral subluxation in the second image (arrow).

Torn supraspinous ligament (yellow arrow), interspinous edema (red arrow) and ligamenta flavum (blue arrow).

Case Discussion

Translation-rotation spine injury are usually severe which usually involves the posterior ligamentous complex (PCL), they are characterized by horizontal displacement of one vertebra with respect to another.

They are characterized by

  • unilateral or bilateral perched or dislocated facet joints
  • vertebral body translation or rotation.
  • splaying of the spinous processes with widening of the interspinous space, avulsion fracture of the superior or inferior aspects of contiguous spinous processes

Common findings include transverse process fractures and rib fractures.

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Case information

rID: 76660
Published: 27th Apr 2020
Last edited: 29th Apr 2020
Inclusion in quiz mode: Included

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