In the case of our patient, we had a dilemma as to when and how to perform the surgical procedure. In terms of early diagnosis of cervical spine injuries, there are numerous studies that have confirmed the much higher sensitivity and specificity of CT scanners as compared with conventional radiography, especially when there is injury at the craniocervical junction. The ATLS protocol (Advanced Trauma Life Support protocol) is to be followed in the initial clinical evaluation of trauma patients suspected of having cervical spine and spinal cord injury. If an injured person survives a cervical spinal cord injury, it is vitally important to diagnose the injury immediately and perform early surgical treatment. In the case of our patient, although the dislocation of the cervical spine was extreme, there was no injury to the major blood vessels (vertebral artery, common carotid artery) nor was there any injury to the surrounding vital structures (trachea, esophagus). Spinal cord injuries caused by luxation and/or dislocation of the cervical spine, at the level C3-C7 vertebra, lead to motor and sensory paralysis below the level of the injury and sphincter dysfunction. Gupta showed the flexion/distraction injury is associated with vertebral artery injury, and on the other hand Biffl did not find a significant pattern in the mechanism of injury or the level of cervical spine injury associated with injury to the vertebral artery. Transection of the spinal cord in the cervical region of the spine caused by traumatic dislocation is an injury that often leads to death, especially when it is a spinal cord injury in the upper cervical spine because of respiratory impairment and vascular lesions. On the 16th day after the injury, the patient’s overall condition deteriorated further, asystole was registered on the monitor, cardiac rhythm was not restored, despite the application of necessary measures of cardiopulmonary resuscitation, and the patient was pronounced deceased. Several days after the surgery her body temperature increasing in the subsequent days to 39.9☌, there was an increase in markers of sepsis (PCT) and inflammatory markers (CRP, WBC) in the blood. She was immediately intubated, transport cervical immobilization was applied, supportive therapy was administered, and the patient was transported to the University Clinical Center of Serbia Emergency Center in Belgrade, which is the main trauma center in Serbia.Ĭomputed tomography revealed complete traumatic dislocation of C6/C7 with consequent transection of the spinal cord ( Figs 1 and 2).Ĭervical spine X-ray postoperatively – lateral view: properly positioned osteosynthesis material. Case presentationĪ 22-year-old female patient was injured in a traffic accident while riding in the front passenger seat of a car. We present a case of extreme traumatic dislocation at the C6/C7 level with complete transection of the spinal cord, in a young girl who was riding in a car as a front seat passenger. The most common mechanism of traumatic cervical vertebrae dislocation is hyperextension or hyperflexion with distraction, which occurs most often in traffic accidents. Recovery from neurological deficit is uncertain, even after the administration of appropriate medication and surgical treatment. Cervical spine injuries can be roughly categorized as axial spine injuries (occiput, C1 and C2), and the children are prone to suffer dislocation at this level, and subaxial spine injuries (C3–C7), where traumatic dislocations occur more common. The severity of the injury and treatment depends on injury and patient related factors. Traumatic C6/C7 dislocation, transection of the spinal cord, timing of the surgical procedure, surgical approach Introductionĭue to its particular anatomy (mobility) and function, the cervical spine is subject to a variety of injuries, from muscle strains to complete dislocation, while a significant number of injuries are associated with spinal cord injury and resulting neurological deficit.
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