Initially overseen vertebral body luxation: diagnosed by dynamic fluoroscopy due to delayed dysphagia.
This study relates to the case report of a neurologically intact 13-year-old boy with unrecognized traumatic bipedicular vertebral fracture. He was diagnosed complete vertebral body luxation 1 day later by dynamic fluoroscopy, then successfully treated with surgery that resulted in total recovery. The delayed diagnosis highlights the importance of detailed initial clinical and radiology examinations, even when overt symptoms as diagnostic indicators of severe neurological sequelae expected in similar traumatic vertebral fractures are lacking. A 13-year-old boy, who met with a minor bicycle accident, was presented with two small forehead lacerations but without pain or clinical neurological symptoms for radiological examination, which showed no abnormalities. The following day, however, the patient complained about dysphagia and underwent dynamic fluoroscopy for the assessment of deglutition that revealed a total block of contrast medium. Computer tomography (CT) of the cervicothoracic junction showed a bipedicular thoracic vertebral fracture and a hooked vertebral body luxation causing mechanical dysphagia but, surprisingly, without compression of the spinal cord. The patient fully recovered after carefully carried out protracted distension and orthopaedic surgery with vertebral fusion. One year after surgery, the patient had clinically resumed normal function, and CT showed a sufficient vertebral bony consolidation with anatomical alignment. This case exemplifies the importance of careful initial clinical examination and spinal CT after accidents encompassing an increased risk of spinal fractures, even if neurologically unapparent.
Wick
Marius C
MC
Department of Radiology, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria. marius.wick@i-med.ac.at
Rieger
Michael
M
D000293:Adolescent; D001265:Athletic Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D001642:Bicycling / Q000293:injuries; D006259:Craniocerebral Trauma / Q000150:complications; D003680:Deglutition Disorders / Q000209:etiology* / Q000503:physiopathology; D003951:Diagnostic Errors / Q000517:prevention & control; D004935:Esophageal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D004947:Esophagus / Q000000981:diagnostic imaging / Q000293:injuries / Q000503:physiopathology; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D004204:Joint Dislocations / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D008297:Male; D016103:Spinal Fractures / Q000150:complications* / Q000000981:diagnostic imaging* / Q000601:surgery; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries* / Q000601:surgery; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014143:Traction; D016896:Treatment Outcome
N Engl J Med. 2000 Jul 13;343(2):94-9
10891516
J Trauma. 2000 Sep;49(3):450-6
11003322
J Pediatr Surg. 2001 Aug;36(8):1107-14
11479837
Pediatrics. 2001 Aug;108(2):E20
11483830
J Neurosurg. 2002 Apr;96(3 Suppl):259-66
11990832
Spine (Phila Pa 1976). 2002 Jul 1;27(13):E321-4
12131753
Radiologe. 2006 Jun;46(6):527-41; quiz 542-3
16607557
J Trauma. 1993 Mar;34(3):342-6
8483172
J Bone Joint Surg Am. 1993 Jul;75(7):988-95
8335674
Eur Spine J. 1994;3(4):184-201
7866834
Clin Pediatr (Phila). 1995 Feb;34(2):90-5
7729113
Radiology. 1999 Jul;212(1):117-25
10405730
Childs Nerv Syst. 2005 Feb;21(2):122-7
15609065
Clin Orthop Relat Res. 1977 Nov-Dec;(129):172-6
608271