Surgical management of severely displaced pediatric seat-belt fracture-dislocations of the lumbar spine associated with occlusion of the abdominal aorta and avulsion of the cauda equina: a report of two cases

Paraplegia After Seat Belt Abdominal Aorta Occlusion Associated With L4 Chance Fracture

Blunt traumatic injury to the chest or abdomen can produce injury to the aorta, which can compromise perfusion to the lower spinal cord. This report presents the case of a seat belt-restrained driver who sustained blunt abdominal trauma and progressive paraplegia. The trauma produced an acute occlusion of the abdominal aorta associated with an L4 Chance fracture and multiple bowel injuries. The Chance fracture occurred two levels below the aortic occlusion. The significant aortic atherosclerosis changes in this patient could have triggered the complete occlusion two levels above the fracture. An aortic injury associated with a vertebral fracture represents a severe and potentially lethal condition. Lower limb ischemia in the setting of a blunt abdominal injury could lead to a high diagnostic suspicion of abdominal aortic injury. Treatment of the vascular injury should be performed without delay to prevent or reduce permanent neurological deficits and ischemic injuries.

Large central disc herniation causing cauda equina syndrome in an adolescent. A case report

•

Cauda equina syndrome is a surgical emergency that requires early diagnosis and prompt intervention.

•

Cauda equina syndrome is an extremely rare condition in the pediatric population with horrible complications if the diagnosis is delayed or missed.

•

Lumbar disc herniation is relatively uncommon in children.

•

In this age group, this is the first paper in the English written literature reporting a case of lumbar disc herniation complicated by CES in an adolescent.

Background

Cauda equina syndrome is a surgical emergency that requires early diagnosis and prompt intervention. It is a challenging diagnosis with a wide variety of clinical presentations that may delay the diagnosis and result in complications that severely affect the patient’s quality of life.

Case report

We present a case of a 15-years-old child affected with acute cauda equina syndrome (CES) secondary to an acute disc herniation after lifting a heavy object. The patient was treated with decompressive laminectomy and discectomy that resulted in significant neurological improvement.

Discussion

Etiologic factors of CES in the pediatric population include tumors, trauma, iatrogenic injuries, spinal dysraphism, constipation and inferior vena cava syndrome. This case is being reported for the rarity of this syndrome in pediatric population especially when the etiological factor is acute disc herniation, which is also rare in this particular population.

Conclusion

This report is thought to increase the index of suspicion of CES in this age group especially in the presence of inciting event allowing early diagnosis and better outcomes.

Mid-lumbar traumatic spondyloptosis without neurological deficit: A case report and literature review

INTRODUCTION

Spondyloptosis is a form of vertebral dislocation and the most advanced form of spondylolisthesis. Traumatic spondyloptosis is usually caused by high-energy impact and results in unstable spine deformity and spinal canal deformation, which lead to severe spinal cord injury. Traumatic spondyloptosis is mostly reported in the lumbo-sacral junction, while it is rarely documented in mid-lumbar segments. To the best of the authors' knowledge, only 16 cases of mid-lumbar spondyloptosis have been described previously. Herein, we present a L3 to L4 spondyloptosis case that did not involve neurological deficit.

PATIENT CONCERNS

A 42-year-old man presented to the emergency department after an accident involving a fall. The patient developed severe back pain and spinal deformity, while his neurologic function remained intact. Radiological examinations indicated complete posterior vertebral dislocation at L3 to L4 and a fracture at the bilateral pelvic ischial tuberosity without major vessel injury or severe dura sac compression.

DIAGNOSES

L3 to L4 complete vertebral dislocation, pelvic ischial tuberosity fracture.

INTERVENTIONS

For treatment, the patient underwent fracture reduction, L3 to L4 intervertebral fusion, and internal fixation 7 days post-injury.

OUTCOMES

Postoperative digital radiography showed the correction of the spinal deformity. The patient was pain-free and fully rehabilitated 3 months after the surgery. At the 1-year follow-up, the patient was completely asymptomatic and had achieved normal alignment.

CONCLUSIONS

We reported an L3 to L4 traumatic spondyloptosis case that involved intact neurology, which is the first-ever reported mid-lumbar spondyloptosis case that involved complete posterior column and neural sparing. For the treatment of traumatic spondyloptosis without neurological deficit, restoring stability and preventing secondary cord injury should be taken into consideration.

Endovascular management of lap belt-related abdominal aortic injury in a 9-year-old child

Blunt abdominal aortic trauma is a rare occurrence in children with only a few patients having been reported in the literature. Most such cases have been described in the context of lap belt injuries. We report a 9-year-old boy who suffered lap belt trauma to the abdomen during a high-speed road traffic accident resulting to the well-recognized pattern of blunt abdominal injury, that is, the triad of intestinal perforation, fractures of the lumbar spine, and abdominal aortic injury. The latter presented with lower limb ischemia due to dissection of the infrarenal aorta and right common iliac artery. Revascularization was achieved by endovascular means using 2 self-expanding stents in the infrarenal aorta and the right common iliac artery. This case is one of the few reports of lap belt-related acute traumatic abdominal aortic dissection in a young child and highlights the feasibility of endovascular management in the pediatric population.

[Fractures of the thoracic and lumbar spine in children and adolescents]

BACKGROUND

Only 1.5-2% of all fractures in children and adolescents are fractures of the thoracic and lumbar spine. Treatment is most often conservative. This study compares the own experience with the recent literature.

MATERIAL AND METHODS

Over a 48 month period all patients with fractures of the thoracic and lumbar spine, younger than 16 years were included prospectively. Of the patients 67 underwent follow-up investigations after 3-36 months.

RESULTS

The average age of the patients was 11.9 years. Sports (53%) and traffic (28%) accidents were most frequent. Fractures most often appeared in the mid-thoracic (47%) and thoracolumbar spine (41%). Operative treatment was performed in 9 cases (10.4%). Secondary loss of alignment was not observed neither after conservative nor operative treatment. Neurological deficits (n=2) did not completely improve.

CONCLUSIONS

Most fractures of the thoracic and lumbar spine heal fast and without any sequelae. Unstable fractures of type B and C (exclusively occurring as a result of traffic accidents) need operative stabilization as in adults.

Sudden-onset back pain and cauda equina syndrome in an adolescent: a case report

Recent epidemiological studies have shown that childhood back pain is a common complaint often prompting medical attention and that it is infrequently the result of serious etiology. This challenges the traditional view that childhood back pain was an uncommon and ominous symptom, always indicative of significant pathology. We report the case of an adolescent boy who presented to the pediatric emergency department with what initially seemed to be benign back pain. This case illustrates an extremely rare ED presentation of myxopapillary ependymoma, which rapidly evolved into cauda equina syndrome requiring urgent neurosurgical intervention. A review of pediatric back pain and cauda equina syndrome is presented.

Traumatic posterior lumbosacral spondyloptosis in a six-year-old: a case report and review of the literature

STUDY DESIGN

Report of a traumatic posterior lumbosacral spondyloptosis in a 6-year-old.

OBJECTIVES

To describe this type of fracture-dislocation in children. To evaluate a possible trauma mechanism. To evaluate specific characteristics of this type of lesion in children.

SUMMARY OF BACKGROUND DATA

Fractures of the lumbar spine in children are rare. They are without exception caused by high-energy trauma. Fracture-dislocations mostly occur in the anterior direction. There are several reports of traumatic retrolisthesis in adults. To our knowledge, this is the first report of a retrolisthesis at the lumbosacral junction in a child.

METHODS

While sitting, a 6-year-old boy was hit by a truck. He presented with a flaccid paraparesis below L3. Radiologic investigations showed a posterior spondyloptosis at L5-S1. He was treated by open reduction with a pediatric posterior spinal instrumentation and posterolateral grafting.

RESULTS

After 1 year, the patient showed good radiologic fracture reduction and graft incorporation. There was no pain in the lumbar area. There was still a complete neurologic deficit beneath the L3 level, with loss of bladder and anal sphincter function. The patient was entered into a children's rehabilitation program 5 weeks after surgery and is continuously improving his overall functional level.

CONCLUSION

Traumatic retrolisthesis of the lumbosacral spine is extremely rare, especially in children. We believe shear force while sitting is the key traumatic factor. We believe a simple posterior fusion with posterolateral grafting is sufficient to stabilize the spine in children. Extensive soft tissue damage causes an elevated risk of infection. Because of root avulsion, the level of paralysis can be several levels higher than the level of dislocation.