Posterior-Only Vertebral Column Resection for Neglected Post-traumatic Thoracolumbar Fracture-Dislocation With Neurological Recovery: A Case Report.

Abstract

Severe neglected post-traumatic thoracolumbar fracture-dislocation may result in rigid kyphotic deformity, sagittal imbalance, chronic pain, and delayed neurological compromise. We report the case of a middle-aged patient who presented with symptomatic rigid thoracolumbar kyphosis three years after an inadequately treated vertebral fracture. Radiological evaluation demonstrated a fixed angular deformity with translational instability and significant sagittal imbalance. The patient underwent single-stage, posterior-only, vertebral column resection with long-segment pedicle screw fixation and circumferential anterior column reconstruction. Adequate deformity correction and restoration of sagittal alignment were achieved without intraoperative neurological deterioration. Postoperatively, the patient demonstrated significant improvement in pain, posture, and functional mobility, with neurological recovery from American Spinal Injury Association (ASIA) Impairment Scale grade D preoperatively to ASIA grade E at final follow-up. This case highlights posterior-only vertebral column resection as an effective salvage strategy in severe neglected post-traumatic thoracolumbar deformity when limited osteotomies are unlikely to achieve adequate decompression or alignment restoration.