Thoracolumbar junction translation injury in a patient with ankylosing spondylitis, a case report

Introduction: The thoracic spine is stable because of kyphotic alignment, rib cage, and costovertebral joints. Any compression or kyphosis in the thoracic spine always causes spinal cord injury. Clinical case: A 47-year-old male with complaints of back pain 1 day prior to admission, after he sustained a motorbike crush and landed on his back. The pain, radiates to both limbs, associated with severe spasms, numbness, and weakness in his lower extremities, however no incontinence. No other associated injuries were reported. 25 years ago he had a history of tuberculosis of the spine with progressive deformity of the back, he was treated medically without surgery. On examinations: Gibbus at T11-L1, with hyper-pigmented post-inflammatory skin and an easily palpable spine, power 1/5 right and 2/5 left lower limbs, Sensation and bulbocarvenosus reflex were intact. Upper limbs were neurologically intact. All laboratory investigations including FBP, ESR, Electrolytes, renal and liver function tests were all within normal range. After radiological imaging, a final diagnosis of Spinal Cord Injury, ASIA C. AO classification type T12-L1:C/T9L1:A4/N3/M2 was made. He was kept on a thoracolumbar corset 6 weeks after being initiated on spine protocol. He was discharged 8 weeks this time patient had no back pain but no improvement was noted neurologically. After a year of thoracolumbar corset and physiotherapy, he reported no more back pain, no numbness to lower limbs, and power 3/5 right and 4/5 left lower limbs, with intact sensation. However, no changes were observed radiologically. Clinical discussion: Due to the instability of fracture-dislocation, surgical treatment is recommended to realign the spine but for this case with back deformity and fractured vertebra bodies, it is best not to temper with reduction and fixation as it would further worsen the neurological deficit of the patient, during maneuvers while doing the reduction. Conclusion: Fracture-dislocation of the thoracic spine can impact the physical and mental well-being of the patients. Surgical fixation and instrumentation are ideal but in cases where surgical intervention would further impair the neurological function of the patient conservative management is the goal.