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Delayed Sub-axial Fracture Dislocation Surgical Management: Technical Notes and Review of the Literature
The surgical treatment of delayed, unstable sub-axial cervical spine injuries is challenging. Multiple treatment regimens have been described in the literature, although there is no consensus regarding the best treatment approach. This report presents a 35-year-old obese woman who experienced a dela...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Cureus
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290902/ https://www.ncbi.nlm.nih.gov/pubmed/37366433 http://dx.doi.org/10.7759/cureus.39539 |
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author | Alhelal, Fahad AlAssiri, Suhail Aleissa, Sami I Konbaz, Faisal M Abaalkhail, Majed Altahan, Husam |
author_facet | Alhelal, Fahad AlAssiri, Suhail Aleissa, Sami I Konbaz, Faisal M Abaalkhail, Majed Altahan, Husam |
author_sort | Alhelal, Fahad |
collection | PubMed |
description | The surgical treatment of delayed, unstable sub-axial cervical spine injuries is challenging. Multiple treatment regimens have been described in the literature, although there is no consensus regarding the best treatment approach. This report presents a 35-year-old obese woman who experienced a delayed sub-axial fracture-dislocation following a motor vehicle accident (MVA) and was successfully managed after three weeks via pre-operative traction followed by a novel single-surgery, single-approach technique with pedicle screws and tension-band wiring as a reduction method. A 35-year-old obese woman with a body mass index (BMI) of 30.1 sustained a frontal impact MVA and suffered from complete quadriplegia below C5 (American Spinal Cord Association Injury A) three weeks prior to presentation. She was intubated and presented with a Glasgow Coma Scale score of 11/15. Trauma computed tomography (CT) showed an isolated spine injury. Moreover, whole-spine CT showed an isolated cervical spine injury involving a basin tip fracture, a comminuted C1 arch fracture, a C2 fracture, and a C6-C7 fracture-dislocation. In addition, magnetic resonance imaging revealed cord contusion at the same level, with C1-C2 left atlantoaxial joint instability. Neck magnetic resonance angiograms and carotid CT angiograms showed left vertebral artery attenuation. She was admitted to the intensive care unit and taken for C6-C7 reduction and instrumentation using only a posterior approach after medical optimization and the application of sufficient traction. Delayed cervical spine fracture-dislocation imposes a challenge for surgical reduction. However, a proper reduction can be achieved through a sufficient duration of pre-operative traction and an isolated anterior or posterior approach. |
format | Online Article Text |
id | pubmed-10290902 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | Cureus |
record_format | MEDLINE/PubMed |
spelling | pubmed-102909022023-06-26 Delayed Sub-axial Fracture Dislocation Surgical Management: Technical Notes and Review of the Literature Alhelal, Fahad AlAssiri, Suhail Aleissa, Sami I Konbaz, Faisal M Abaalkhail, Majed Altahan, Husam Cureus Orthopedics The surgical treatment of delayed, unstable sub-axial cervical spine injuries is challenging. Multiple treatment regimens have been described in the literature, although there is no consensus regarding the best treatment approach. This report presents a 35-year-old obese woman who experienced a delayed sub-axial fracture-dislocation following a motor vehicle accident (MVA) and was successfully managed after three weeks via pre-operative traction followed by a novel single-surgery, single-approach technique with pedicle screws and tension-band wiring as a reduction method. A 35-year-old obese woman with a body mass index (BMI) of 30.1 sustained a frontal impact MVA and suffered from complete quadriplegia below C5 (American Spinal Cord Association Injury A) three weeks prior to presentation. She was intubated and presented with a Glasgow Coma Scale score of 11/15. Trauma computed tomography (CT) showed an isolated spine injury. Moreover, whole-spine CT showed an isolated cervical spine injury involving a basin tip fracture, a comminuted C1 arch fracture, a C2 fracture, and a C6-C7 fracture-dislocation. In addition, magnetic resonance imaging revealed cord contusion at the same level, with C1-C2 left atlantoaxial joint instability. Neck magnetic resonance angiograms and carotid CT angiograms showed left vertebral artery attenuation. She was admitted to the intensive care unit and taken for C6-C7 reduction and instrumentation using only a posterior approach after medical optimization and the application of sufficient traction. Delayed cervical spine fracture-dislocation imposes a challenge for surgical reduction. However, a proper reduction can be achieved through a sufficient duration of pre-operative traction and an isolated anterior or posterior approach. Cureus 2023-05-26 /pmc/articles/PMC10290902/ /pubmed/37366433 http://dx.doi.org/10.7759/cureus.39539 Text en Copyright © 2023, Alhelal et al. https://creativecommons.org/licenses/by/3.0/This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Orthopedics Alhelal, Fahad AlAssiri, Suhail Aleissa, Sami I Konbaz, Faisal M Abaalkhail, Majed Altahan, Husam Delayed Sub-axial Fracture Dislocation Surgical Management: Technical Notes and Review of the Literature |
title | Delayed Sub-axial Fracture Dislocation Surgical Management: Technical Notes and Review of the Literature |
title_full | Delayed Sub-axial Fracture Dislocation Surgical Management: Technical Notes and Review of the Literature |
title_fullStr | Delayed Sub-axial Fracture Dislocation Surgical Management: Technical Notes and Review of the Literature |
title_full_unstemmed | Delayed Sub-axial Fracture Dislocation Surgical Management: Technical Notes and Review of the Literature |
title_short | Delayed Sub-axial Fracture Dislocation Surgical Management: Technical Notes and Review of the Literature |
title_sort | delayed sub-axial fracture dislocation surgical management: technical notes and review of the literature |
topic | Orthopedics |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10290902/ https://www.ncbi.nlm.nih.gov/pubmed/37366433 http://dx.doi.org/10.7759/cureus.39539 |
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