title: Floating Thoracic Spine After Double, Noncontiguous Three-Column Spinal Fractures.
abstract: BACKGROUND
  Double, noncontiguous, 3-column spinal injuries are a rare phenomenon most often caused by high-energy trauma. The resulting multilevel, fracture-dislocation injuries represent 2 separate 3-column lesions and produce a floating spine segment between the 2 fracture dislocation sites. Only a few cases of these rare, posttraumatic injuries have been reported previously; however, all of these included a combination of injuries in the cervical, thoracic, lumbar, and/or sacral spine.
  
  
  METHODS
  We present the first report of a case of double-level spinal injury isolated to the thoracic spine, with an intermediate floating spinal segment in a 48-year-old man after a 30-foot fall. In our case, the standard 3 above and 2 below pedicle instrumentation was not sufficient to stabilize the thoracic spine.
  
  
  CONCLUSIONS
  We consider the evaluation and surgical management of these fractures and discuss how a standard "3 above-2 below" approach may not be sufficient to stabilize these unstable injuries. In the case of severe, noncontiguous double chance fractures of the spine, we recommend a more extensive anteroposterior approach to reduce the risk of hardware failure and worsening spinal deformity.
authors.affiliation: Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Arsalaan A
authors.initials: AA
authors.lastname: Salehani
authors.affiliation: Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Griffin R
authors.initials: GR
authors.lastname: Baum
authors.affiliation: Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Brian M
authors.initials: BM
authors.lastname: Howard
authors.affiliation: Department of Neurological Surgery, Emory University School of Medicine, Atlanta, Georgia, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Holland
authors.affiliation: Department of Neurological Surgery, Emory University School of Medicine, Grady Memorial Hospital, Atlanta, Georgia, USA. Electronic address: faiz.ahmad@emory.edu.
authors.forename: Faiz U
authors.initials: FU
authors.lastname: Ahmad
mesh_terms: D006801:Humans; D008297:Male; D008875:Middle Aged; D009985:Orthopedics / Q000379:methods*; D016103:Spinal Fractures / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D013124:Spinal Injuries / Q000150:complications* / Q000000981:diagnostic imaging; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D015898:Tomography Scanners, X-Ray Computed
keywords: Fracture dislocation; Spine trauma; Thoracic fracture; Three-column injury