The patient was admitted to Emergency of Shmaisani hospital 24-December-2014 after suffering severe trauma by sticking between 2 heavy objects, that caused fracture of the right 5-7 ribs and dislocation of D5-6 with paraplegia  and internal bleeding. He came with under-water seal tube from another hospital. He mentioned that he did not suffer loss of consciousness, but got immediate paraplegia. Radiologic investigations were performed, demonstrating shuttered liver and rupture spleen with dislocation of C5-6 with fracture right 5-7th ribs. The patient was bleeding actively and emergency laparatomy was done with repair of the lever and resection of 2/3 of the spleen. There was retroperitoneal hematoma over and behind the spleen. MRI of the dorsal spine showing contusion of the spinal cord with minimal compression due to 7-9 mm dislocation of the D5-6.

After correcting the homeostasis and the patient was seen by cardiologist, it was decided to perform fixation through right thoracotomy approach.

The right 5th rib exposed and resected from the fracture site anterior about 15 cm. Thoracotomy achieved with deflation of the right lung. Double-lumen intubation was applied. The D5 and D6 were exposed and the slipped disc material was noted with the chip fracture in the right upper corner of D6 was removed. Using Medtronic CDH ANTARES system was used with caudal and rostral spikes 23 mm. CDH FAS 6.5x35 mm screws were used with 2 rods 5.5 mm diameter with the long one 60 mm and the short one 45 mm to reduce and fix the D5-6 levels. Strict hemostasis and routine closure of the wound and the underwater seal was left in place.

Smooth postoperative recovery. The neurologic status still the same. The patient was sent to the ICU.

During the impact of trauma the spinal cord suffered major injury with dislocation around 3-4 cm, but it returned immediately to the seen at the preoperative MRI and CT-scans. It is hard to tell early the prognosis in such case and the aim of surgery to make the patient set as early as possible.