Two Adjacent Levels Dislocation of the Cervical Spine Managed via an Anterior Only Approach : A Case Report

Abstract

We report the rare case of a 52-year-old man who presented an incomplete tetraplegia after a hang gliding accident. Computed tomography revealed a complete bilateral facet fracture-dislocation at the C4C5 level, with a unilateral facet fracture-dislocation on the left side at the C3C4 level; there was also a sagittal fracture of the fifth cervical vertebra extending through the middle of its body with a second fracture through the posterior arch. The patient was taken urgently to the operating room and closed reduction maneuvers were performed under general anesthesia, followed by an anterior prevascular approach for C3 to C5 fusion with two iliac crest grafts and a plate. Patient’s muscle strength was 3/5 on all four limbs on discharge and between 4/5 and 5/5 at one year. He stopped self-catheterization nine months after the accident. At two years follow-up, X-rays and CT scan showed a stable construct with satisfactory fusion. This is the first paper, in the literature, to describe double level contiguous cervical dislocation with a sagittal split fracture, and managed via an anterior only approach.