A 28-year-old man was admitted to the emergency department of a regional hospital presenting, as a result of a car accident, with polytrauma with fracture of the 6th costal arch and right pulmonary contusion, renal laceration with right subcapsular and suprarenal haematoma, haematoma of the abdominal wall, dislocation of the right elbow and ligament injury in the knee on the same side, injuries with loss of substance in both lower limbs, and no signs of TBI.
The patient required orotracheal intubation and assisted ventilation due to respiratory failure, and blood transfusions due to acute anaemia, and was admitted to the ICU. Extubated after 48 hours without incident, he was transferred to the hospital ward 24 hours later, where he remained for ten days, and a plaster cast was placed on the right lower limb.
Since being discharged from hospital, 13 days after the traumatism, the patient presents pain at dorsal-lumbar level, initially attributed to the renal traumatism, which in the last 7 days is associated with a subjective sensation of loss of strength with paresthesia-dysesthesia in both lower limbs, more pronounced when lying down, and in the last 72 hours, difficulty in starting urination and constipation. One month after the trauma, the patient attended the regional hospital where an X-ray of the thoracic and lumbar spine was performed, showing an increase in the interspinous distance in the anteroposterior projection, and in the lateral projection an anterior displacement of the vertebral body of T11 on T12, with a possible dislocation of the articular facets at this level, and a minimal fracture of the most anterior portion of the vertebral body of T12. An MRI of the area was performed in which the existence of haematomas in the canal was ruled out, confirming the findings of the X-ray, and with a doubtful image of spinal cord contusion. Blood was also observed at the level of the interspinous ligament. The patient was referred to our department.
On admission, the patient presented mild paraparesis (4+/5), predominantly proximal, with no sensory deficits, mild symmetrical bilateral patellar hyperreflexia, with no signs of pyramidal release. A CT scan was performed, which in axial sections revealed the existence of an abnormal arrangement of the T11-T12 facets, with stenosis of the canal at that level, the existence of a sign of the naked facet, and the sagittal and three-dimensional reconstruction confirmed dislocation and blockage of the articular facets at the T11-T12 level bilaterally.
The patient underwent surgery through a posterior approach, with excision of a scar magma at both joints, curettage of the veneers of the upper FA of T12, and open reduction of the dislocation by means of distraction-extension manoeuvres, achieving almost complete reduction after performing a bilateral partial laminectomy, which facilitated reduction, followed by T11-T12 fixation with pedicle screws, bars and autologous graft. The patient evolved favourably, his neurological symptoms disappearing in the first week, and he was discharged pain-free and ambulating normally.