Authors: Abdulmajed Khalifa Alali , Malak Mohammed Alshabi

Abstract

Background

Although rare, high-energy occupational crush injuries to the thoracolumbar spine can have catastrophic consequences due to significant mechanical instability and neurological damage. When compounded by spinal canal damage and acute myelopathy, complex fracture patterns that combine flexion-distraction injury and burst fracture features pose a considerable diagnostic and therapeutic challenge.

Case Presentation

A 36-year-old man employee who was previously in good health arrived at the emergency room after suffering a crush injury at work when a big object fell on his back. A neurological examination indicated full bilateral lower-limb paralysis with substantial sensory loss. However, the patient was aware and attentive upon arrival, with a Glasgow Coma Scale score of 15/15 and retained peripheral pulses. An unstable T12 fracture that exte]nded through both pedicles and posterior elements was seen on the first computed tomography, which was consistent with a flexion-distraction (Chance-type) injury. Retropulsed fracture fragments caused moderate-to-severe spinal canal stenosis. Acute T11 superior endplate compression fracture and displaced right posterior tenth and eleventh rib fractures were among the associated injuries. Magnetic resonance imaging confirmed T11–T12 fractures and T12 retropulsion, which compress the distal dorsal spinal cord and are linked to cord edema and traumatic myelopathy. The patient required immediate posterior decompression with T11 laminectomy and posterior instrumented fixation from T10 to L1 due to the unstable fracture pattern, spinal canal impairment, and significant neurological loss. Imaging taken after surgery showed stable hardware with no signs of displacement or loosening.

Conclusion

This illustration shows that a single fracture pattern shouldn't be used to categorize serious thoracolumbar injuries. Burst and flexion-distraction hybrid injuries can be exceedingly unstable disorders that require fast decompression, expert surgical planning, and proper stabilization.

Keywords: Occupational crush injury, thoracolumbar fracture, T12 fracture, flexion-distraction injury, chance fracture, traumatic myelopathy, burst fracture, spinal cord injury.