Skip to main content
SpringerLink
Log in

Noncontiguous double-level unstable spinal injuries

  • Original Article • SPINE - TRAUMA
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Noncontiguous double-level unstable spinal injuries (NDUSI) are uncommon and have not been well described. In this study, we aimed to better understand the patterns of NDUSI, in order to recommend proper diagnostic and treatment methods, as well as to raise awareness among traumatologists about the possibility of these uncommon injuries.

Methods

A total of 710 consecutive patients with spine fractures were treated for >9 years since 2007 at a single regional trauma center. Of them, 18 patients with NDUSI were reviewed retrospectively.

Results

The incidence of NDUSI was 2.5 % of all spine fractures. In 17 of 18 patients (94.7 %), NDUSI was caused by a high-energy trauma. Nine patients (50.0 %) exhibited complete neurological deficit. Spinal cord injury occurred in the cranial injured region in all American Spinal Injury Association grade A cases. In one case, a second fracture was overlooked at the initial examination.

Conclusion

NDUSI are common in cases of high-energy trauma and should be taken into consideration at the initial examination. A second fracture may be easily overlooked because of the high frequency of concomitant severe spinal cord injury in the cranial injured region and/or loss of consciousness due to associated injuries. To avoid overlooking injuries, full spine computed tomography is useful at the initial examination. Operative reduction and internal fixation with instrumentation through a posterior approach is recommendable for cases of NDUSI. In elderly patients, a very rapid stabilizing surgery should be planned before aspiration pneumonia occurs or the pulmonary condition worsens.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Griffith HB, Gleave JRW, Taylor RG (1966) Changing patterns of fracture in the dorsal and lumbar spine. Br Med J 1:891–894

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Iencean SM (2002) Double noncontiguous cervical spinal injuries. Acta Neurochir (Wien) 144:695–701

    Article  CAS  Google Scholar 

  3. Powell JN, Waddell JP, Tucker WS, Transfeldt EE (1989) Multiple-level noncontiguous spinal fractures. J Trauma 29:1146–1150

    Article  CAS  PubMed  Google Scholar 

  4. Cho SK, Lenke LG, Hanson D (2006) Traumatic noncontiguous double fracture-dislocation of the lumbosacral spine. Spine J 6:534–538

    Article  PubMed  Google Scholar 

  5. Calenoff L, Chessare JW, Rogers LF, Toerge J, Rosen JS (1978) Multiple level spinal injuries: importance of early recognition. AJR Am Roentqenol 130:665–669

    Article  CAS  Google Scholar 

  6. Korres DS, Boscainos PJ, Papaqelopoulos PJ, Psycharis I, Goudelis G, Nikolopoulos K (2003) Multiple level noncontiguous fractures of the spine. Clin Orthop Relat Res 411:95–102

    Article  Google Scholar 

  7. Vaccaro AR, An HS, Lin S, Sun S, Balderston RA, Cotler JM (1992) Noncontiguous injuries of the spine. J Spinal Disord 5:320–329

    Article  CAS  PubMed  Google Scholar 

  8. Gupta A, el Marsi WS (1989) Multiple spinal injuries: incidence, distribution and neurologic patterns. J Bone Joint Surg Br 71:692–695

    Article  CAS  PubMed  Google Scholar 

  9. Beldekos A, Korres DS, Nikolakakos GA (1981) Chance’s fracture in a double level fracture of the spine. Injury 13:34–36

    Article  CAS  PubMed  Google Scholar 

  10. Henderson RL, Reid DC, Saboe LA (1991) Multiple noncontiguous spine fractures. Spine 16:128–131

    Article  CAS  PubMed  Google Scholar 

  11. Hadden WA, Gillespie WJ (1985) Multiple level injuries of the cervical spine. Injury 16:628–633

    Article  CAS  PubMed  Google Scholar 

  12. Wittenberg RH, Hargus S, Steffen R, Muhr G, Bötel U (2002) Noncontiguous unstable spine fractures. Spine 27:254–257

    Article  PubMed  Google Scholar 

  13. Mahan ST, Mooney DP, Karlin LI, Hresko MT (2009) Multiple level injuries in pediatric spinal trauma. J Trauma 67:537–542

    Article  PubMed  Google Scholar 

  14. Mortazavi MM, Dogan S, Civelek E, Tubbs RS, Theodore N, Rekate HL, Sonntag VK (2011) Pediatric multilevel spine injuries: an institutional experience. Childs Nerv Syst 27:1095–1100

    Article  PubMed  Google Scholar 

  15. Carreon LY, Glassman SD, Campbell MJ (2004) Pediatric spine fractures: a review of 137 hospital admissions. J Spinal Disord Tech 17:477–482

    Article  PubMed  Google Scholar 

  16. Korres DS, Katsaros A, Pantazopoulos T, Haltofilakidis-Garofalidis G (1981) Double or multiple level fractures of the spine. Injury 13:147–152

    Article  CAS  PubMed  Google Scholar 

  17. Dai LY, Jia LS (1996) Multiple non-contiguous injuries of the spine. Injury 27:573–575

    Article  CAS  PubMed  Google Scholar 

  18. Tearse DS, Keene JS, Drummond DS (1987) Management of non-contiguous vertebral fractures. Pareplesia 25:100–105

    Article  CAS  Google Scholar 

  19. Keenen TL, Antony J, Benson DR (1990) Non-contiguous spinal fractures. J Trauma 30:489–491

    Article  CAS  PubMed  Google Scholar 

  20. Pellise F, Bago J, Villanueva C (1992) Double-level spinal injury resulting in “en block” dislocation of the lumbar spine. A case report. Acta Orthop Belgica 58:349–352

    CAS  Google Scholar 

  21. Magerl F, Aebi M, Gertzbein SD, Harms J, Nazarian S (1994) A comprehensive classification of thoracic and lumbar injuries. Eur Spine J 3:184–201

    Article  CAS  PubMed  Google Scholar 

  22. Allen BL Jr, Ferguson RL, Lehmann TR, O’Brien RP (1982) A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976) 7:1–27

    Article  Google Scholar 

  23. Anderson LD, D’Alonzo RT (1974) Fractures of the odontoid process of the axis. J Bone Joint Surg Am 56:1663–1674

    Article  CAS  PubMed  Google Scholar 

  24. Levine AM, Edwards CC (1985) The management of traumatic spondylolisthesis of the axis. J Bone Joint Surg Am 67:217–226

    Article  CAS  PubMed  Google Scholar 

  25. Takami M, Yamada H, Nohda K, Yoshida M (2014) A minimally invasive surgery combining temporary percutaneous pedicle screw fixation without fusion and vertebroplasty with transpedicular intracorporeal hydroxyapatite blocks grafting for fresh thoracolumbar burst fractures: prospective study. Eur J Orthop Surg Traumatol 24(Suppl 1):159–165

    Article  Google Scholar 

  26. Takami M, Nohda K, Sakanaka J, Nakamura M, Yoshida M (2014) Usefulness of full spine computed tomography in cases of high-energy trauma: a prospective study. Eur J Orthop Surg Traumatol 24(Suppl 1):167–171

    Article  Google Scholar 

  27. Horn EM, Theodore N, Feiz-Erfan I, Lekovic GP, Dickman CA, Sonntag VK (2006) Complications of halo fixation in the elderly. J Neurosurg Spine 5:46–49

    Article  PubMed  Google Scholar 

  28. Daentzer D, Flörkemeier T (2009) Conservative treatment of upper cervical spine injuries with the halo vest: An appropriate option for all patients independent of their age? J Neurosurg Spine 10:543–550

    Article  PubMed  Google Scholar 

  29. Delcourt T, Bégué T, Sainttyves G, Mebtouche N, Cottin P (2015) Management of upper cervical spine fractures in elderly patients: current trends and outcomes. Injury 46:S24–S27

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We declare that no organizations funded our research.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan

    Masanari Takami, Motohiro Okada, Yoshio Enyo, Hiroshi Iwasaki, Hiroshi Yamada & Munehito Yoshida

Authors
  1. Masanari Takami
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Motohiro Okada
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Yoshio Enyo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Hiroshi Iwasaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hiroshi Yamada
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Munehito Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Masanari Takami.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed consent

Informed consent was obtained from all individual patients included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Takami, M., Okada, M., Enyo, Y. et al. Noncontiguous double-level unstable spinal injuries. Eur J Orthop Surg Traumatol 27, 79–86 (2017). https://doi.org/10.1007/s00590-016-1855-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-016-1855-y

Keywords

Search

Navigation