Introduction: Double noncontiguous three column spinal injuries are a rare phenomenon caused by high-energy trauma resulting in multi-level fracture-dislocation injuries. Because these injuries represent two separate three-column lesions, they result in a floating spine segment in between the two fracture dislocation sites.

Methods: Only a few cases of post-traumatic double level three column spinal injuries have been reported, however, all of these included a combination of injuries in the cervical, thoracic, lumbar, and/or sacral spine. We present the first such case of a double level spinal injury isolated to the thoracic spine.

Results: A 48 year-old man presented after a 30-foot fall with an ASIA A spinal cord injury, with a T6 sensory level. CT scan revealed a fracture dislocation at T5-6, with a second fracture dislocation at T9-10 with an intervening segment of ‘floating’ thoracic spine. He was taken to the OR for T2-12 instrumented fusion. Imaging 6 months later revealed failure of the fusion construct, loosening and pullout of the pedicle screws at T11 and T12 as well as collapse of the T10 vertebral body. He was revised with anterior T10 corpectomy and posterior T2-L3 instrumented fusion, with transdiscal screw from T12-T11. Dual titanium rods with dual cobalt chrome rods were also employed as a four-rod construct for added stability.

Conclusions: This case exhibits the need for unique surgical technique in cases with post-traumatic noncontiguous double spinal injury. The standard ‘three above-two below’ approach may not be sufficient to stabilize these very unstable injuries. In the case of severe, non-contiguous double chance fractures of the spine, we recommend a more extensive anterior-posterior approach to reduce the risk of hardware failure and further neurologic decompensation.

Patient Care: Unique fractures such as a double, non-contiguous chance fractures of the thoracic spine are not often seen, and when coupled with an ASIA A spinal cord injury, can prove to be a difficult case to manage for the traumatologist and trauma neurosurgeon. We present our experience with this unique case to advocate for a more extensive surgical approach to avoid further neurologic decompensation and future hardware/fusion failure.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance of unique surgical planning and treatment in double, non-contiguous double chance fractures of the thoracic spine. 2) Discuss, in small groups, the unique challenges posed by a patient with a double, non-contiguous double chance fracture with an ASIA A spinal cord injury. 3) Identify an effective treatment for a patient with a severe and unique injury, such as a double, non-contiguous double chance fracture with an ASIA A spinal cord injury

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