Floating Thoracic Spine After Double, Noncontiguous Three-Column Spinal Fractures

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. Case Description 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.