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Traumatic fracture dislocation of the thoracic spine sparing both the spinal cord and aorta

A 33-year-old man was involved in a high-speed, motorcycle accident, striking his back on metal railing by the side of the highway. On arrival at our trauma centre, the patient was hypotensive (86/60 mmHg) and tachycardic (110 beats/min). He was fully orientated, with intact power and sensation in all limbs. Computed tomography scan showed a translational fracture dislocation, consistent with grade-5 spondylolisthesis, at the level of T5–T6, with the T5 vertebral body positioned anteriorly and to the left of the T6 vertebral body (Fig. 1). Associated spinal injuries were a comminuted axial plane fracture of the T4 vertebral body, and fractures to T3–T5 spinous processes, and right T4–T5 and left T2–T6 transverse processes. Critically, the vertebral bodies of T4 and T5 were completely dissociated from their posterior elements, thus, minimizing displacement of the spinal canal and trauma to the spinal cord itself (Fig. 2). The inferior margin of the T5 vertebral body also indented the thoracic aorta (Fig. 1). After discussion with the radiologist and surgeons from trauma, vascular and cardiothoracic specialties, it was felt that the spine was extremely unstable and that there were no further imaging modalities that could definitively exclude aortic injury. Due to impending danger of catastrophic neurological and vascular injury, the patient was taken straight to surgery. Under general anaesthesia, the patient was carefully placed prone. Cardiothoracic and perfusion personnel were on standby, and the theatre was prepared in case emergency thoracotomy was required. Surgical access was via a posterior midline thoracic spine incision and a costo-transverse approach. Pedicle screws were inserted bilaterally in T1–T3 and T7–T9, but only on the left side