Delayed-Onset Leg Weakness Caused by Posterior Migration of a Herniated Disc to the Thecal Sac Mimicking Epidural Hematoma in a Flexion-Distraction Injury of the Lumbar Spine: A Case Report

STUDY DESIGN: Case report. OBJECTIVES: To document the first known case of posterior migration of a herniated disc in a lumbar flexion-distraction injury. SUMMARY OF LITERATURE REVIEW: Lumbar disc herniation is sometimes confused with epidural hematoma, especially when the disc migrates posterior to the thecal sac. There has been no report of posterior migration of a herniated disc after a lumbar flexion-distraction injury. MATERIALS AND METHODS: A 47-year-old woman with no pertinent medical history was diagnosed with a flexion-distraction injury of the L2–L3 vertebrae after a motor vehicle accident. The patient had no neurological deficit initially. Magnetic resonance imaging (MRI) showed a space-occupying lesion with T2 hyperintensity and T1 isointensity on the dorsal side of the thecal sac at L2–L3. After posterior lumbar fixation and fusion, progressive leg weakness occurred 1 week postoperatively. RESULTS: A second operation revealed no evidence of epidural hematoma, but a sequestrated disc. Decompression and sequestrectomy were performed, and the patient's neurological status had recovered fully at 4 months postoperatively. CONCLUSIONS: This case highlights the potential for posterior migration of a herniated disc with flexion-distraction injuries of the thoracolumbar spine. Discontinuity of the posterior annulus fibrosus on MRI may aid the distinction of posterior migration of a herniated disc from epidural hematoma. Because posterior migration of a herniated disc is associated with progressive neurological deficits, surgeons must consider decompression surgery when such herniation is suspected, even in the absence of neurological symptoms.

Double Level Extension Distraction Thoracic Spine Injuries with Concomitant Double Level Sternal Fractures: A Case Report

Extension distraction injury of the spine is rare. A majority of these cases occur in the cervical region and at an isolated level. Rare instances of this injury have been described in an ankylosed or fused spine. This case report describes a rare two level extension distraction thoracic spine injury in an otherwise healthy adult resulting from a motor vehicle accident.

Flexion-distraction Injury in Cervico-thoracic Junction: A Case Report / 대한척추외과학회지

Injuries at the cervico-thoracic junction can be difficult to diagnose (with an incidence as high as 9% of all spinal injuries) and to stabilize, because of anatomic complexities. We report a case with that was treated with a lateral mass screw and transpedicular screw-rod fixation for a flexion-distraction injury at the cervico-thoracic junction and we present a review of the literature.

Short Segment Fixation of Flexion-Distraction Injuries in Thoracolumbar Spines

PURPOSE: To evaluate the efficacy of short segment fixation in flexion-distraction injuries of thoracolumbar junction. MATERIALS AND METHODS: Twenty-five patients with a flexion-distraction injury in thoracolumbar junction confirmed by radiogram or MRI and stabilized with a short construct spanning short segment were included in this study. We investigated the location of fractures, type of fractures, anterior or posterior vertebral body height, and preoperative and postoperative kyphotic angle of injuried motion-segments on radiologic examinations and clinical outcome on the Oswestry score. RESULTS: A significant correction of deformity was achieved, from a mean preoperative kyphosis of 17.3 degrees to a mean postoperative kyphosis of 8.4 degrees. The loss of correction were minimal. The mean Oswestry score was 6.9, with 84% of patients having minimal disability (<20%) and no correlation with age, sex, the location of fractures, type of fractures, change of kyphotic angle. CONCLUSION: This study demonstrates the efficacy of posterior open reduction and short segment fixation of flexion-distraction injuries.

Distribution and Patterns of Posterior Column Injury in Flexion-Distraction Injuries of Thoracolumbar Spine / 대한척추외과학회지

STUDY DESIGN: A retrospective analysis of the distribution and patterns of posterior column injury in flexion-distraction injuries of the thoracolumbar spine. OBJECTIVES: To recognize the various types of posterior column injury in terms of the path of the distraction force in flexion-dis-traction injuries of the thoracolumbar spine. SUMMARY OF LITERATURE REVIEW: As posterior column injuries are associated with instability of the spine, many authors have described and classified posterior column injuries. However, there are no descriptions or classifications in terms of the path of the distraction force in the literature. MATERIALS AND METHOD: The preoperative plain X-rays, axial CT, MRI (in 5 patients) and operation records of 34 patients were reviewed in relation to the patterns of posterior column injury. RESULTS: Posterior column injuries can be classified into two main types. In Type I(30/34), the distraction failure started from the spinous process one level above the fractured body (Type IA) or the posterior ligament complex between the spinous processes of the fractured and the level above (Type IB). In Type II(4/34), the distraction failure started from the spinous process of the fractured vertebra and from the interspinous ligament between the fractured level and the level below. CONCLUSIONS: Posterior column injuries can be described according to their starting point and the extent of the distraction force. Of these, Type IB was the most common. Using this classification, the injury of the posterior column in injuries of the thora-columbar spine fracture can be predicted.

Burst Fracture with Distraction Injury in the Posterior Column of the Thoracolumbar Spine / 대한정형외과학회잡지

PURPOSE: To evaluate the characteristics of burst fracture with distraction injury of the posterior column and provide diagnostic information categorizing thoracolumbar fractures causing instability. MATERIALS AND METHODS: Twenty-one patients with a thoracolumbar burst fracture and posterior column injury, as confirmed by radiogram or MRI were included in this study. To evaluate clinical features, the characteristics of the injury mechanism and the physical findings were reviewed. The degree of kyphotic deformity, compression ratio and canal encroachment were measured. RESULTS: The group consisted of ten men and eleven women with a mean age of 39.3 years. The most common cause of injury was a fall from height in 14 cases. A superficial tenderness was noted in all cases. Of twenty-one patients, eleven had an associated spinal fracture. Kyphotic deformity, compression ratio and canal encroachment were 19.9o, 23% and 14% in an average, respectively. CONCLUSION: Our data demonstrated that burst fracture with distraction injury of the posterior column has no remarkable radiographic parameter despite the associated significant instability. This finding suggests that the index of suspicion for this type of injury is important, and physicians should be aware of the integrity of the posterior column.