Diagnosis and treatment of multiple level and noncontiguous spinal fractures

English Keywords:Spine fractures  Multiple-level  Noncontiguous  Diagnosis  Treatment

English Abstract:

  【Abstract】 Objective：To investigate the diagnosis and treatment of multiple level and noncontiguous spinal fractures.Method：30 cases suffering ｆｒｏｍ　multiple level and noncontiguous spinal fractures were admitted to our institute from January 2007 to December 2010.There were 26 males and 4 females with the age ranging from 16 to 64 years.All the cases had a natural history of trauma.The duration from injury to admission was from 2 hours to 3 days.Total spine X-ray radiographic survey and three-dimensional CT scan were accomplished in the emergency room.One case died of cerebral hernia at the day of admission，and others underwent total spine MRI within 4 days after admission.14 cases suffered with 2 segments fractures，11 cases with 3 segments fractures，3 cases with 4 segments fractures and 2 cases with 5 segments fractures.A total of 83 segments were involved.Diagnosis was postponed in 6 cases（7 segments） with delayed time of 2 to 4 days.All delayed-diagnosed　ｃａｓｅｓ were determined by total spine MRI.According to ASIA grading system，there were 5 grade A，2 grade B，7 grade C，4 grade D and 11 grade E.8 cases were ａｃｃｏｍｐａｎｉｅｄ by cerebral trauma，4 ｂｙ　rib fracture，3　ｂｙ hemopneumothorax，4 ｂｙ　pulmonary contusion，2 ｂｙ　rupture of the spleen，1 ｂｙ　kidney contusion，10 ｂｙ　limb fracture and 2 ｂｙ　pelvic fracture.14 cases suffering ｆｒｏｍ　burst fractures ｗｅｒｅ　complicated with spinal cord injury underwent surgery.The average time from injury to surgery is 6.2 day（4-9 days）.10 simple compression fractures with the loss of vertebraｌ height less than 1/3 and no neurological deficit were treated conservatively.5 cases abandoned treatment.Result：23 patients were followed up for 10 months to 44 months with a mean time of 28 months，ｗｈｉｌｅ　1 case undergoing conservative treatment died of pulmonary embolism 6 days after admission.14 cases treated surgically had the average Cobb′s angle improved from 20.8°（range，16.6°-22.3°） of preoperation to 6.1°（range，4.7°-7.4°） of postoperation，and 6.7°（range，4.6°-7.7°） at final follow-up.No loss of vertebral height was noted，and all fractureｄ vertebrｅ healed at final follow-up.Among 12 patients with neurological deficit before operation，8 cases had ASIA grade improved 1-2 grade，ａｎｄ　4 cases remained unchanged（3 grade A and 1 grade B） at final follow-up.No implant failure，nonunion ｏｒ　neurological deterioration were noted during followｉｎｇ up.9 cases undergoing conservative treatment had bony-union and no loss of vertebral height，and no neurological deterioration was noted either.Conclusion：Missed diagnosis in multiple level ａｎｄ　noncontiguous spinal fractures ｉｓ usually encountered.It ｉｓ recommended that total spine X-ray radiographic survey and three-dimensional CT should be accomplished routinely to the cases with multiple trauma.The spine MRI ｉｓ performed if necessary.If the fractures are unstable or combined with spinal cord deficit，surgical treatment is suggested as soon as possible for better healing effect.