Case report: A complete lower cervical fracture dislocation without permanent neurological impairment.
Fracture dislocation
Lower cervical spine
Neurological impairment
Journal
BMC musculoskeletal disorders
ISSN: 1471-2474
Titre abrégé: BMC Musculoskelet Disord
Pays: England
ID NLM: 100968565
Informations de publication
Date de publication:
14 Jun 2024
14 Jun 2024
Historique:
received:
03
12
2023
accepted:
11
06
2024
medline:
15
6
2024
pubmed:
15
6
2024
entrez:
14
6
2024
Statut:
epublish
Résumé
Complete fractures and dislocations of the lower cervical spine are usually associated with severe spinal cord injury. However, a very small number of patients do not have severe spinal cord injury symptoms, patients with normal muscle strength or only partial nerve root symptoms, known as "lucky fracture dislocation". The diagnosis and treatment of such patients is very difficult. Recently, we successfully treated one such patient. A 73-year-old male patient had multiple neck and body aches after trauma, but there was sensory movement in his limbs. However, preoperative cervical radiographs showed no significant abnormalities, and computed tomography (CT) and magnetic resonance imaging (MRI) confirmed complete fracture and dislocation of C7. Before operation, the halo frame was fixed traction, but the reduction was not successful. Finally, the fracture reduction and internal fixation were successfully performed by surgery. The postoperative pain of the patient was significantly relieved, and the sensory movement of the limbs was the same as before. Two years after surgery, the patient's left little finger and ulnar forearm shallow sensation recovered, and the right flexion muscle strength basically returned to normal. This case suggests that when patients with trauma are encountered in the clinic, they should be carefully examined, and the presence of cervical fracture and dislocation should not be ignored because of the absence of neurological symptoms or mild symptoms. In addition, positioning during handling and surgery should be particularly avoided to increase the risk of paralysis.
Sections du résumé
BACKGROUND
BACKGROUND
Complete fractures and dislocations of the lower cervical spine are usually associated with severe spinal cord injury. However, a very small number of patients do not have severe spinal cord injury symptoms, patients with normal muscle strength or only partial nerve root symptoms, known as "lucky fracture dislocation". The diagnosis and treatment of such patients is very difficult. Recently, we successfully treated one such patient.
CASE PRESENTATION
METHODS
A 73-year-old male patient had multiple neck and body aches after trauma, but there was sensory movement in his limbs. However, preoperative cervical radiographs showed no significant abnormalities, and computed tomography (CT) and magnetic resonance imaging (MRI) confirmed complete fracture and dislocation of C7. Before operation, the halo frame was fixed traction, but the reduction was not successful. Finally, the fracture reduction and internal fixation were successfully performed by surgery. The postoperative pain of the patient was significantly relieved, and the sensory movement of the limbs was the same as before. Two years after surgery, the patient's left little finger and ulnar forearm shallow sensation recovered, and the right flexion muscle strength basically returned to normal.
CONCLUSION
CONCLUSIONS
This case suggests that when patients with trauma are encountered in the clinic, they should be carefully examined, and the presence of cervical fracture and dislocation should not be ignored because of the absence of neurological symptoms or mild symptoms. In addition, positioning during handling and surgery should be particularly avoided to increase the risk of paralysis.
Identifiants
pubmed: 38877489
doi: 10.1186/s12891-024-07586-9
pii: 10.1186/s12891-024-07586-9
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
465Subventions
Organisme : Hunan Provincial and Municipal Joint Project of Natural Science Foundation
ID : S2022JJSSLH0568
Informations de copyright
© 2024. The Author(s).
Références
Liu P, Yang J-S, Liu T-J, et al. Complete fracture-dislocation of the lower cervical spine without permanent neurologic sequela: the typical imaging changes [J]. Spine Journal: Official J North Am Spine Soc. 2016;16(3):e197–9.
doi: 10.1016/j.spinee.2015.10.016
Bhatia S, Sharma BS, Mathuriya SN, et al. Complete dislocation with burst fracture of the lower cervical spine. Case Rep [J] Paraplegia. 1993;31(8):542–4.
Baker RP, Grubb RL. Complete fracture-dislocation of cervical spine without permanent neurological sequelae. Case report [J]. J Neurosurg. 1983;58(5):760–2.
doi: 10.3171/jns.1983.58.5.0760
pubmed: 6834124
Millar TMS, Mcconnachie CCPJIE. Complete fracture-dislocation of the lower cervical spine associated with significant ligamentous disruption of the upper cervical spine: a case of survival without permanent neurological sequelae [J]. Injury Extra. 2007;38(9):317–9.
doi: 10.1016/j.injury.2006.12.183
Okereke I, Mmerem K, Balasubramanian D. The management of cervical spine injuries - a literature review [J]. Orthop Res Reviews. 2021;13:151–62.
Allen BL, Ferguson RL, Lehmann TR et al. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine [J]. Spine, 1982, 7(1).
Vaccaro AR, Hulbert RJ, Patel AA, et al. The subaxial cervical spine injury classification system: a novel approach to recognize the importance of morphology, neurology, and integrity of the disco-ligamentous complex [J]. Spine. 2007;32(21):2365–74.
doi: 10.1097/BRS.0b013e3181557b92
pubmed: 17906580
Pitman MI, Pitman CA, Greenberg IM. Complete dislocation of the cervical spine without neurological deficit. A case report [J]. J Bone Joint Surg Am. 1977;59(1):134–5.
doi: 10.2106/00004623-197759010-00030
pubmed: 833167
Kang JD, Figgie MP, Bohlman HH. Sagittal measurements of the cervical spine in subaxial fractures and dislocations. An analysis of two hundred and eighty-eight patients with and without neurological deficits [J]. J Bone Joint Surg Am Volume. 1994;76(11):1617–28.
doi: 10.2106/00004623-199411000-00004
Zhou F, Zou J, Gan M, et al. Management of fracture-dislocation of the lower cervical spine with the cervical pedicle screw system [J]. Ann R Coll Surg Engl. 2010;92(5):406–10.
doi: 10.1308/rcsann.2010.92.5.406
pubmed: 20487593
pmcid: 3180314
Ramieri A, Domenicucci M, Cellocco P, et al. Traumatic spondylolisthesis and spondyloptosis of the subaxial cervical spine without neurological deficits: closed re-alignment, surgical options and literature review [J]. Eur Spine J. 2014;23(Suppl 6):658–63.
doi: 10.1007/s00586-014-3560-z
pubmed: 25200147
Shen Y, Shen H-l, Feng M-L, et al. Immediate reduction under general anesthesia and single-staged anteroposterior spinal reconstruction for fracture-dislocation of lower cervical spine [J]. J Spin Disord Tech. 2015;28(1):E1–8.
doi: 10.1097/BSD.0000000000000065