Figure 4

Conventional open reduction and instrumentation with secondary anterior surgery in a polytraumatized patient with compression fracture of T12 and complete burst fracture of L1. This case features a 39 year old male patient following a fall from height (ISS = 41). The patient was unconscious at the site of the injury and transferred after tracheal intubation to the trauma centre. Following primary survey and whole-body CT-Scan, severe traumatic brain injury with epidural hematoma, retroperitoneal bleeding with bilateral lung contusions and instable spine injuries from a complete burst fracture of L1 with substantial spinal canal compromise (type A3.3) and adjacent compression fracture of T12 (type A1.2) were revealed (images A-D). The patient was positioned prone and simultaneous surgery was performed for evacuation of epidural hematoma and stabilization of the spine. Posterior fusion using a conventional approach was performed to achieve optimized reduction of the posterior wall fragment and strongest stabilization using a cross-link and bone graft (image E). Following uneventful recovery from intracranial injuries, the patient was operated anterior using an expandable cage on day 10 post trauma (images F-G). Removal of the internal fixator after 14 months released cranial motion segment T11-T12 and showed sufficient bisegmental anterior fusion (images H-I). (Adopted from Heyde CE, Stahel PF, Ertel W. "Was gibt es Neues in der Unfallchirurgie" in: Meßmer, Jähne, Neuhaus: Was gibt es Neues in der Chirurgie? Ecomed Medizin 2005).