Complete fracture-dislocation of the cervical spine without permanent neurological sequelae: case report

Abstract

Background: Cervical spine injuries occur in up to 3% of all trauma patients. Fracture-dislocation of the lower cervical spine is typically present with severe spinal cord injury in which the body of one vertebra rests fully anterior to the next body. With this kind of injury, there are very few examples where there is no permanent neurological deficit, and those that do exist are extremely rare. Case Presentation: A 19-year-old Saudi male patient was presented by ambulance to the emergency department. He was a front-seat passenger in a vehicle involved in a road accident. The patient was unconscious, Glasgow Coma Scale (GCS) (8/15), and quadriparetic. He was intubated and put on a mechanical ventilator and vasopressor support for persistent hypotension. American Spinal Injury Association impairment scale was a grade A. Initial management and resuscitation was done according to Advanced trauma life support (ATLS) guidelines: cervical collar application, logrolling, analgesic therapy, vitals normalized, and general condition stabilized. Skull traction was performed on admission. The patient underwent anterior cervical open reduction + C6/7 pedicle screw, and lateral mass screw internal fixation was performed. Conclusion: We report a rare case of complete fracture dislocation of C5/C6 listhesis with bilateral facet lock, with C7 fracture, C7/T1 listhesis, and bilateral facet lock. The patient presented with quadriparesis and was successfully treated with posterior reduction and fusion. The mechanism of injury, which was thought to be flexion and compression, was deduced by the patient's history and the results of physical and neuroimaging examinations.