K Sridhar1, M C Vasudevan, B Ramamurthi. 1. Postgraduate Institute of Neurological Surgery, Dr. A. Lakshmipathi Neurosurgical Centre, VHS Medical Centre, TTTI Post Chennai, Madras, India.
Abstract
BACKGROUND: Difficulty in proper visualization of the upper thoracic spine in plain radiographs allows for injuries at this level to be missed, especially in a busy trauma center. This window of error is increased when the patient presents with no symptoms or signs of neurologic or spinal involvement, as upper thoracic dislocations commonly present early. CASE DESCRIPTION: The authors report a 19-year-old girl who developed progressive paraparesis 18 hours following initial presentation with a scalp avulsion injury. Imaging revealed a complete dislocation at T1-T2, with cord compression. Emergency surgical decompression and reconstruction of her spinal column was performed with a 360-degree stabilization. There was immediate neurologic improvement and on follow-up the patient is neurologically normal. CONCLUSIONS: The case highlights the difficulty in visualization of the upper thoracic spine in routine radiographs taken in a casualty setting. Treating physicians should have a low threshold for investigation of cervico-thoracic dislocations. The possibility of a delayed progressive dislocation should be kept in mind when dealing with injuries with a potential for spinal injury.
BACKGROUND: Difficulty in proper visualization of the upper thoracic spine in plain radiographs allows for injuries at this level to be missed, especially in a busy trauma center. This window of error is increased when the patient presents with no symptoms or signs of neurologic or spinal involvement, as upper thoracic dislocations commonly present early. CASE DESCRIPTION: The authors report a 19-year-old girl who developed progressive paraparesis 18 hours following initial presentation with a scalp avulsion injury. Imaging revealed a complete dislocation at T1-T2, with cord compression. Emergency surgical decompression and reconstruction of her spinal column was performed with a 360-degree stabilization. There was immediate neurologic improvement and on follow-up the patient is neurologically normal. CONCLUSIONS: The case highlights the difficulty in visualization of the upper thoracic spine in routine radiographs taken in a casualty setting. Treating physicians should have a low threshold for investigation of cervico-thoracic dislocations. The possibility of a delayed progressive dislocation should be kept in mind when dealing with injuries with a potential for spinal injury.