Complete fracture-dislocation of the thoracic spine associated with spontaneous neurologic decompression. A case...

"Complete" fracture-dislocation of the thoracic spine without neurologic deficit, a rarely described injury, occurred in a 29-year-old coal miner. Partial lesions or those without neurologic deficit may be associated with spontaneous decompression. Gross translational displacement of one vertebrae on another generally compresses interposed neural structures between the columns and/or fragments. Multiple pedicular fractures or posterior column disruption from the displaced anterior column functionally widens the neural canal, even with vertebral bodies side by side. The rib cage stabilizes the thoracic spine, decreasing the risk of neurologic injury. Although many surgeons proclaim the advantages of early open reduction and internal fixation, reduction may not always be necessary in this type of severe injury. Reduction entails highly significant risks, especially in neurologically uncompromised individuals with severe thoracic displacement.