Figure 3

Clinical example of "spine damage control" for an unstable L1 complete burst fracture (AO/OTA 53-A3.3) with 50% spinal canal narrowing (A, B) in a 50-year old lady who sustained an axial loading trauma mechanism in a commercial airliner crash at Denver International Airport. The patient was neurologically intact (ASIA grade E). She was taken for a posterior reduction and two-level instrumentation T12-L2 on day 1. Intraoperative fluoroscopy films show an excellent reduction of the L1 burst fracture with restoration of near-anatomic vertebral body height and sagittal profile in lordosis (C). The postoperative CT scan (D- F) demonstrates a significant clearance of the anterior spinal canal fragment by pure ligamentotaxis (arrow in E, compared to arrow in A). The patient tolerated the operative procedure well. She was mobilized on postoperative day (POD) #1 with physical therapy and discharged on POD #2 to fly back to her hometown, where she followed up with a local spine surgeon for anterior completion fusion. This example emphasizes the safety and efficacy of the "spine damage control" concept.