T7 vertebral burst fracture with left pedicle separated from vertebral body and displaced in vertebral canal without neurologic deficits in a 12 years old motorbike competition rider

Abstract

Introduction: CL, aged 12 years and 4 months, suffered multiple thoracic spine fractures in an accident as a rider in motorbike competition reporting T7 body fracture with anterior wedging associated with displaced left pedicle fracture at level of vertebral body- pedicle union, pedicle was displaced inside vertebral canal completely obliterating sub arachnoid space. There were associated T5, T6, T8, T9, T10 body wedge fractures. Imaging shown no sign of spinal cord lesion. Clinical exam shown no nervous deficits. Material and Methods: Treatment strategy had two goals, initial T7 fracture stabilization and nervous structures decompression. After initial stabilization with pedicle screws inserted in T5, T6, T8 and T7 vertebras, and only right-side rod mounted, we performed T6 and, partially, T7 left laminotomy: this manoeuvre allowed the direct visualization of left pedicle fragment with facet joint dislocated in the vertebral canal and compressing lateral surface of dural sac. The fragment was accurately isolated from sac surface and removed; no dural lesion showed after fragment removal, the dural sac regained its original dimension. Left rod is inserted, we performed transverse left side T6-T7-T8 arthrodesis and posterior right side T6-T7-T8 arthrodesis. Intra operatory neurophysiologic monitoring is performed during all operation, with continuous normal signal passage. After surgery patient neurologic exam was unchanged. Patient is braced by cast and set up three days after surgery. 30 days after surgery cast is substituted by custom brace that patient wears continuously for 2 months. Nine months after surgery T6-T7-T8 arthrodesis is complete on x-rays exam and instrumentation is removed One year after stabilization patient has regained all his previous life activities, even motorbike competitions, with new motorbike accident and left tibial plate fracture. Discussion: As children motorbike use and competitions are becoming more and more diffuse, motorbike accidents with resulting lesions are more common, including severe spine fractures. The patient of this case report is included in a cohort of 6 cases of thoracic fractures caused by injuries during young riders’ motorbike competitions in patients under 15 years of age. Two of them have been treated by surgery and the other 4 patients have been treated by cast/bracing without surgery.