Cervical cord transection secondary to C2-C3 dissociation

Abstract

A 14-year-old previously healthy female was brought to the emergency department (ED) after being involved in a high speed motor vehicle accident. After resuscitation, a computed tomography (CT) scan brain revealed multifocal intraventricular and subarachnoid hemorrhage (Figure 1). CT scan of the cervical spine showed a traumatic spondylolisthesis at C2/C3 with posterior displacement of C3 vertebral body indicating a probable spinal cord injury at the C2/C3 level (Figure 2). MRI scan of the cervical spine showed a severe cervical central spinal canal stenosis with cord displacement and compression reflecting a combination of contusion and myelopathy (Figure 3). The patient was diagnosed with cervical cord transection due to C2- C3 dissociation. She underwent posterior arthrodesis extending from the occiput C1 to C1-2, C2-3, C4-5, C5-C6; using of an occipital place, lateral mass screws fixation under live fluoroscopy (Figure 4). Because of a surgical wound CSF leak, a lumbar drain was placed for one week. After two month as an inpatient, the patient was only able to move her facial muscles and had suffered from stage 2 bed ulcers. She was medically and hemodynamically stable, and was discharged to a traumatic brain injury facility.