Traumatic thoracic spinal cord transection without spinal fracture-dislocation or evidence of soft tissue injury: A case report
Keywords:
spinal cord, transection, traumaticAbstract
Background: Traumatic cord transection is uncommon. It is generally a result of high energy spinal trauma with associated vertebral body fracture or dislocation. The level of cord transection mostly corresponds to the level of vertebral injury.The objective of this article is to report a patient with thoracic spinal cord transection in the absence of evidence of fracture-dislocation of the vertebral column, and to purpose potential etiologies of the injury.
Case presentation: A 33-year-old female was referred to UdonThani hospital with history of alteration of consciousness, blunt chest and abdominal injury and acute paraplegia after a motor vehicle accident. The patient had complete paraplegia below the T10 level. Her back had no sign of localized skin lesion but mild tenderness over T6-7 level. MRI cervicothoracic spine revealed long segment spinal transection with gapping from lower T10 to lower T12. There was no associated spinal fracture-dislocation identified by plain radiographic evaluation of cervical, thoracic and lumbar spine. CT chest and abdomen resulted short segment aortic dissection from the level below right renal artery.
Conclusion: Although the etiology of this exceptional case is still unclear, the authors proposed two possible causes of pathology which include 1. Compromised Adamkiewicz’s artery and 2. Chance type injury of flexion-distraction mechanism. Physicians providing patients’ medical care need to keep the potential cord transection in any acute trauma patients in mind even though subtle radiographic abnormalities might be illustrated on plain films.
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