Cervical spine fracture with dislocation

Case contributed by Mohamed Mahmoud Elthokapy

Presentation

Fall from height (4th floor) with collapse and lost consciousness.

Patient Data

Age: 40 years
Gender: Male

Initial CT study

ct

Fracture dislocation of C7/D1 with bilateral facetal dislocation (jumped facets) as well as marked anterolithesis more than 90% (Grade IV).

C7 spinous processes avulsion fracture (Clay shoveler fractures) with gapping and displacement.

Left C7 and to less extent C6 transverse processes fractures.  

C7 para-vertebral and pre-spinal mild soft tissue thickening/hematoma.

Fracture dislocation at C7/D1 with bilateral facetal dislocated (jumped facets) as well as marked anterolisthesis (grade IV) with subsequently compromised spinal canal at this level and spinal cord compression evident by segmental cord abnormal signal (myelopathy), elicits high signal in T2. No evidence of complete cord transection nor disruption of its continuity on axial images.

Injured posterior longitudinal ligament opposite this level with further kink and intra-substance bright heterogeneous signal.

Small anterior epidural thickening with signal alteration (hematoma).

C7-D1 disc appears pseudo bulged anteriorly with prominent annular bulge and stretching and probable annular fissures or rupture.

Prevertebral / retropharyngeal edema is seen at the injury site. Paraspinal soft tissue edema is also noted more prominent posteriorly at the upper cervical region.

Incidental C5-6 posterior central foal disc protrusion is seen mildly indenting the ventral cord.

The patient underwent surgical intervention with spinal fixation immediately after diagnosis.

post operative follow up

ct

Cervical spine fixation using metallic hardware via anterior spinal approach with re-gained cervical alignment.

Postoperative changes include pre-vertebral soft tissue thickening, edema, and gases foci with the surgical drain in situ.

Case Discussion

Unstable C7-T1 fracture-dislocation with locked facets associated with three columns injuries and compressive cord myelopathy underwent rapid surgical correction and fixation aiming to survive the spinal cord and to prevent neurological disability.

Thanks to Dr. Awad Elshehri (neurosurgery consultant) and Dr. Islam Elmeneawy (neurosurgery specialist). 

How to use cases

You can use Radiopaedia cases in a variety of ways to help you learn and teach.

Creating your own cases is easy.