Abstract
IntroductionPost-traumatic subluxations are potentially devastating injuries to the axial skeleton. Of utmost priority are an expedient and timely diagnosis and realignment because of its association with spinal cord and nerve root trauma, which lead to progressive deleterious neurological deficits. A good radiological study of the occipitocervical joint and first thoracic vertebra is key to a successful early diagnosis. However, cases might still fail to be diagnosed, leading to trouble. A case of post-traumatic subluxation at the C7 vertebral level with an unusual neurological pattern is presented here.Case presentationA 35-year-old farmer from the Sindh province of Pakistan presented to our neurology department after a fall 2 months earlier and complained of lower limb pain and difficulty in walking. He had numbness in both of his lower limbs up to his umbilical region, with sparing of bladder function along with intact strength in the upper extremities bilaterally.ConclusionsOur case highlights the unusual sparing of upper limbs and intact urinary continence with severe lower limb deficits in a 70% subluxation. Our case is unusual because highly detrimental effects such as quadriplegia are expected with such extreme subluxation, but our patient presented with only lower limb deficits. This case serves as a reminder to emergency medicine doctors, spine surgeons, and even radiologists (a) to evaluate spine injuries by using computed tomography in trauma patients to identify artifact around a suspected injury and (b) to be mindful of negative conventional radiographs.
Highlights
Post-traumatic subluxations are potentially devastating injuries to the axial skeleton
Our case highlights the unusual sparing of upper limbs and intact urinary continence with severe lower limb deficits in a 70% subluxation
Our case is unusual because highly detrimental effects such as quadriplegia are expected with such extreme subluxation, but our patient presented with only lower limb deficits
Summary
This case serves as a reminder to emergency medicine doctors, spine surgeons, and even radiologists that spine injuries should be evaluated by CT in patients with trauma in order to identify artifact around a suspected injury. Consent Written informed consent was obtained from the patient for publication of this manuscript and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal. Authors’ contributions MS developed the idea for the case report, wrote part of the report, and reviewed it. ASMH headed the study, is the chair of the department, revised the draft of the case report, and provided a critical review of the study. SB helped with the examination of the patient and wrote the Case presentation section. All authors read and approved the final manuscript. Author details 1Dow Medical College, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi 74200, Pakistan. Author details 1Dow Medical College, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi 74200, Pakistan. 2Department of Neurosurgery, Jinnah Post Graduate medical Center, Rafiquee Shaheed Road, Karachi 75510, Pakistan. 3Civil Hospital Karachi, Dow University of Health Sciences, Baba-e-Urdu Road, Karachi 74200, Pakistan
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