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XXIII Congreso Nacional de la Sociedad Española de Neurocirugía
Salamanca, 14-17 May 2019
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I. Paredes1, I. Panero Pérez1, C. Eiriz1, L.M. Moreno1, A. Lagares1, J. Fernández Alén1 and D. García Pérez1

1Servicio de Neurocirugía, Hospital 12 de Octubre, Madrid, Spain. 2Hospital 12 de Octubre, Madrid, Spain.

Objectives: To report an unusual pure soft tissue chance fracture located in the thoracic spine.

Methods: We report on a 46-year-old woman who was involved in a road traffic accident. Neurological examination demonstrated paraplegia, while initial CT showed bilateral pneumothorax and haemothorax, rib fractures, a C2 vertebral body fracture with C2-C3 dislocation and active arterial bleeding at the sacral level.

Results: Given the fact that her neurological status did not particularly correspond with what we observed on CT scan, MRI was obtained due to the suspicion that a much more severe occult injury could be present. MRI showed a complete rupture of the posterior ligamentous complex (PLC) along with the intervertebral disc and the posterior longitudinal ligament at T8-T9 level. The patient underwent minimally invasive posterior fixation with pedicle screws. Chance fractures of the thoracic spine are uncommon.

Conclusions: To our knowledge, this is the first report of a pure soft tissue Chance fracture located in the thoracic spine. Given that the initial CT showed no fracture evidence or vertebral malalignment, a high index of suspicion, based on the mechanism of injury, clinical examination and/or concomitant lesions, is necessary to identify such extremely unstable injury. Early recognition is crucial for appropriate therapy and to minimize the extent of neurological deficit.

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Neurocirugía (English edition)

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