A 17-year-old girl was brought to our hospital after sustaining injuries in a vehicle collision. The patient was conscious and cooperated; she had total plegia and anesthe- sia under T7. Her anal reflex was absent, and her American Spinal Injury Association (ASIA) score was an A (complete lesion). Radiological investigation revealed a T7 rotation- distraction–type burst fracture. The patient also had a
hemothorax, for which a thoracic tube was inserted, and the patient was immediately moved to surgery. The patient underwent emergency posterior large decompression and posterior segmental instrumentation. A thoracic computed tomography obtained in the postoperative period revealed that the T8 right pedicle screw was located medially, and this was corrected with revision surgery. The patient did not show neurologic improvement in the early postoperative period. She was referred to a physical therapy and rehabili- tation center. Two years after surgery and completion of a rehabilitation program, neurologic examination showed hypoesthesia below T7. The patient still had motor deficits. There was a minimal increase in anal tonus. Her ASIA score was a B (partial lesion) (Figs. 1–4).