Thoracic spinal cord injury without radiographic abnormality in an adult patient

Background contextThoracic spinal cord injury (SCI) without fractures or discoligamentary injuries in adults is extremely uncommon. This is because of the inherent stability of the thoracic spine provided by the structure of the ribcage, and the increasing stiffness of the overall spine with rising age. Till date, the pathogenesis of this disorder in adults is still unclear.PurposeTo present a case of thoracic SCI without any bony or ligamentous injury of the vertebral column in an adult patient together with an overview of the literature.Study designCase report.MethodsRetrospective description of a case. The charts and the radiological exams of the case were reviewed to explain the unusual neurologic deficit of a 27-year-old male motorcyclist who got involved in a traffic accident and presented with multiple injuries.ResultsClinically, there were signs of an incomplete SCI at the level of T8. Initial radiographs, computed tomography scan, and magnetic resonance images (MRI) revealed no osseoligamentous injury. Multiple rib fractures were seen on the left side. Subsequent MRI performed two days later showed focal cord contusion at level T4 and avulsion of nerve root T4 on the left side.ConclusionsMultiple rib fractures including the 4th rib resulted in violent avulsion of nerve root T4, possibly causing focal myelum contusion. This is an unusual mechanism of neurologic injury in adults, which has not been described before.