Abstract

Background: Vertebral shortening is an emerging treatment for traumatic vertebral dislocations, traditionally performed through open posterior or combined approaches. This case introduces a novel technique integrating vertebral shortening with minimally invasive surgery (MIS) in the acute setting.

Case Description: A 51-year-old male sustained a T8-T9-T10 dislocation and complete spinal cord injury (SCI) American Spinal Injury Association (ASIA) Impairment Scale, following a motor vehicle accident. Surgery was delayed 48 h for hemodynamic stabilization, and then, a hybrid approach was performed: percutaneous fixation (T6-T12), mini-open T9 vertebrectomy, and T8-T10 compression. He had no postoperative neurological recovery, no perioperative complications, and imaging confirmed correct spinal alignment fixation and fusion.

Conclusion: MIS for spinal shortening and fixation in severe dislocations achieved the same goals as traditional open surgery while reducing perioperative complications.

Keywords: Corpectomy, Fracture dislocation, Minimally invasive surgery, Spinal cord injury, Trauma, Vertebral shortening

INTRODUCTION

Vertebral shortening as a treatment for traumatic spinal fracture-dislocations has been utilized for approximately a decade, predominantly through a posterior or combined open approach.[ 1 - 3 , 8 ] Early surgical reduction and stabilization enable the immediate initiation of rehabilitation.[ 9 ] Treatment of thoracic fracture-dislocation utilizing an acute complete vertebrectomy has rarely been reported; here, we described our minimally invasive surgery (MIS) technique for managing an acute thoracic spine T8-T10 fracture-dislocation.

CASE PRESENTATION

A 51-year-old male patient was involved in a frontal motor vehicle collision, following which he developed severe thoracic pain and the sudden onset of paraplegia. He underwent a whole-body computed tomography (CT) scan that revealed posterior T9 spondyloptosis with spinal canal compromise, along with severe chest trauma, multiple rib fractures, and bilateral pulmonary contusions.

He was transferred to our hospital 24 h after the injury. On admission, he was conscious (Glasgow coma scale 15) but in neurogenic shock, presenting with a T9 complete motor/ sensory paralysis. He had bilateral chest tubes and required vasopressor support for neurogenic shock.

The thoracolumbar CT scan documented a T9 burst fracture with retropulsion of nearly the entire body into the spinal canal, and fracture of the posterior elements with added bilateral neuroforaminal involvement at T8-T9 and T9-T10. There were also fractures of the T8 vertebral body/posterior elements, collapse fractures of the superior endplates of T4 and T5, fractures of the left transverse processes of T10 and T11, and bilateral fractures of T8 and T9 [ Figure 1 ].

Figure 1:

(a) Sagittal, and (b) axial sections of Preoperative computed tomography scan of the thoracolumbar spine demonstrating fracture-dislocation and complete comminution of the T9 vertebral body.

Our diagnosis was as follows: spinal cord injury at T9 level (AIS A), T8-T9-T10 fracture-dislocation, and T4-T5 compression fracture.

Surgery and postoperative course

The patient’s clinical condition required surgery be postponed for 48 h to allow for hemodynamic stabilization. Acute spinal shortening was performed, using a hybrid fixation technique that included percutaneous T6-T12 instrumentation and a mini-open T9 vertebrectomy with T8-T10 compression [ Figure 2 ]. Postoperatively, the patient did not recovery any neurological function [ Figure 3 ]. In fact, a year and 10 months after the accident, the follow-up CT scan confirmed consolidation of the vertebral shortening procedure [ Figure 4 ], but his sensory level had risen to T5.

Figure 2:

(a) Percutaneous fixation, (b) mini-open approach with exposure of body bony fragments following the removal of posterior arch fragments, (c) removal of T9 posterior arch and body fragments, (d) T8-T10 compression maneuver performed through a mini-open approach, (e) final view of acute shortening through mini-open approach, and (f) final view of the hybrid approach.

Figure 3:

Postoperative imaging. (a) Computed tomography scan and (b) anteroposterior and lateral X-rays showing T6-T12 fixation, T9 corpectomy, and T8-T9 compression, respectively.

Figure 4:

A computed tomography scan performed 22 months postoperatively confirmed fusion of the vertebral shortening.

DISCUSSION

Vertebral shortening and corpectomy have historically been considered treatment options for non-traumatic pathologies.[ 5 , 7 ] When combined with instrumentation, these techniques reduce spinal cord tension and prevent neuronal damage.[ 5 ] This approach typically involved total or partial vertebral excision, previously performed almost exclusively through an open posterior or combined approach. Notably, the reduction and stabilization of thoracolumbar fractures are not without complications and technical challenges. When spinal shortening is necessary, the shortening and working distance should be minimized to prevent spinal cord injuries, rod fractures, and the development of adjacent segment disease.[ 11 ] Furthermore, patient selection and timing of intervention are crucial. In this case, surgical intervention was delayed for 48 h to allow for hemodynamic stabilization due to chest trauma and neurogenic shock.

MIS Alternative

MIS vertebral shortening and corpectomy procedures aim to reduce patient morbidity compared to traditional open surgery.[ 4 , 10 ] MIS has benefited patients with spinal deformities, infections, and trauma.[ 4 , 6 , 10 ] Here, vertebrectomy with segmental shortening in the acute trauma setting with this hybrid approach integrated percutaneous posterior fixation with a mini-open corpectomy and controlled posterior compression. In this case, vertebral body shortening was performed exclusively at the level of the traumatic injury to achieve interbody fusion, without extending arthrodesis to the adjacent instrumented segments.

At the 2-year follow-up, the patient remained paraplegic with a complete spinal cord injury, but with a sensory level that ascended up to the T5 level. Radiological evaluation confirms complete interbody fusion at the treated levels.

CONCLUSION

Acute vertebral shortening is a viable therapeutic alternative for managing complex spinal injuries characterized by significant anterior column bone defects and neurological impairment with a poor prognosis. Notably, this hybrid technique achieved the same goals as traditional open surgery while reducing expected perioperative complications.

Ethical approval:

The Institutional Review Board approval is not required.

Declaration of patient consent:

The authors certify that they have obtained all appropriate patient consent.

Financial support and sponsorship:

Nil.

Conflicts of interest:

There are no conflicts of interest.

Use of artificial intelligence (AI)-assisted technology for manuscript preparation:

The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI.

Disclaimer

The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.

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