Floating Spine and Other Types of Associated Multiple Simultaneous Unstable Spinal Fractures

Keywords: multiple vertebral fractures, floating spine, trauma, high energy, unstables fractures

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.

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Author Biographies

Guillermo Alejandro Ricciardi, Spine Team, Orthopedics and Traumatology Service, Sanatorio Güemes, Autonomous City of Buenos Aires, Argentina
Spine Team, Orthopedics and Traumatology Service, Sanatorio Güemes, Autonomous City of Buenos Aires, Argentina
Lyanne Julieth Romero Valverde, Spine Team, Orthopedics and Traumatology Service, Sanatorio Güemes, Autonomous City of Buenos Aires, Argentina
Spine Team, Orthopedics and Traumatology Service, Sanatorio Güemes, Autonomous City of Buenos Aires, Argentina
Santiago Formaggin, Spine Team, Orthopedics and Traumatology Service, Sanatorio Güemes, Autonomous City of Buenos Aires, Argentina
Spine Team, Orthopedics and Traumatology Service, Sanatorio Güemes, Autonomous City of Buenos Aires, Argentina
Ignacio Garfinkel, Spine Team, Orthopedics and Traumatology Service, Sanatorio Güemes, Autonomous City of Buenos Aires, Argentina
Spine Team, Orthopedics and Traumatology Service, Sanatorio Güemes, Autonomous City of Buenos Aires, Argentina
Gabriel Carrioli, Spine Team, Orthopedics and Traumatology Service, Sanatorio Güemes, Autonomous City of Buenos Aires, Argentina
Spine Team, Orthopedics and Traumatology Service, Sanatorio Güemes, Autonomous City of Buenos Aires, Argentina
Daniel Oscar Ricciardi, Spine Team, Centro Médico Integral Fitz Roy, Autonomous City of Buenos Aires, Argentina
Spine Team, Centro Médico Integral Fitz Roy, Autonomous City of Buenos Aires, Argentina

References

Griffith HB, Gleave JR, Taylor RG. Changing patterns of fracture in the dorsal and lumbar spine. Br Med J

;1(5492):891-4. https://doi.org/10.1136/bmj.1.5492.891

Tearse DS, Keene JS, Drummond DS. Management of non-contiguous vertebral fractures. Paraplegia

;25(2):100-5. https://doi.org/10.1038/sc.1987.18

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

Keenen TL, Antony J, Benson DR. Non-contiguous spinal fractures. J Trauma 1990;30(4):489-91. PMID: 2325181

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

Green RA, Saifuddin A. Whole spine MRI in the assessment of acute vertebral body trauma. Skeletal Radiol

;33(3):129-35. https://doi.org/10.1007/s00256-003-0725-y

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

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

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

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

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

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)

;38(23):2028-37. https://doi.org/10.1097/BRS.0b013e3182a8a381

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

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

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

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

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

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

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

Iencean SM. Double noncontiguous cervical spinal injuries. Act Neurochir (Wien) 2002;144(7):695-701.

https://doi.org/10.1007/s00701-002-0940-7

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

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

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

Published
2023-06-17
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
Section
Clinical Research

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