Surgical technique: Technical notes on reduction of thoracic spine fracture dislocation

Fracture dislocation of the thoracic spine is a rare spinal injury often resulting from high-energy trauma. Associated soft-tissue thoracic injuries are common and are compounded by the often-associated paraplegia. Exceptionally, there are some cases of thoracic spine dislocations without neurological injuries.1 A major challenge in the surgical management of such spinal fractures is achieving reduction and then maintaining it after stabilization. The goals of surgical management of these unstable spine fractures are 4-fold: (1) achieving reduction; (2) immediate stabilization and maintenance of reduction, coupled with spine fusion; (3) decompression of the neurological elements (if indicated); and (4) early mobilization.2–4 Classic posterior spinal instrumentation, such as screw-plate, hook-rod and screw-rod systems, has been used successfully. It has been shown that most of these unstable injuries can be managed using these techniques without the need for additional combined or staged anterior spinal surgery.5,6 However, recent concerns have been raised that maintenance of reduction, restored height and sagittal balance has not occurred in long-term follow-up using such systems.7,8 As for thoracolumbar, unstable burst fractures, some have advocated that anterior decompression and anterior column reconstructions must be done to avoid delayed loss of coronal and sagittal balance,9 but for fracture dislocations most of the literature has described a posterior approach.10,11 It has been our experience that the use of side-opening pedicle screws facilitates reduction to help achieve the surgical goals previously enumerated.