Abstract
Introduction and Aims: The management of cervical spine dislocation is a challenge and can be a topic of big debate. Delay diagnosis of these injuries presents a bigger challenge. The aim of this study is to review patients who presented and were managed after four weeks from the time of injury.
Method: A retrospective study of 15 patients with unifacet and bifacet dislocation referred to the author four weeks after the injury between 1990 and 2003 were reviewed. Their clinical records and x-rays on admission and up to final discharge from follow-up were studied. Some patients were interviewed by telephone and a recent x-ray was requested. The following factors were assessed: age, mechanism of injury, delay period from the time of injury when referred, clinical picture at presentation, treatment given and clinical picture at final discharge or interview.
Results: The age range at presentation was 24 to 56 years. The delay period to presentation and management by the author was six weeks to three years. At presentation all had neck pain, three had upper limb paraesthesia, six had radiculopathy, four had Frankel D myelopathy and two were neurologically intact. Eleven patients had involvement of C5/6, three had C4/5 and one had C6/7 involvement. Seven patients had been treated by the primary medical team with traction, five with a soft collar for a few weeks, two had no treatment and one was a re-injury. Skeletal traction was applied to all patients on admission. Only three patients were successfully reduced with the prolonged traction; they were further managed by anterior discectomy, fusion and anterior cervical spine plating. The remaining patients were treated by corpectomy of the caudal vertebrae, strut graft and anterior cervical spine plating. None of the patients had posterior surgery. Fusion was achieved in all the patients. Cervical lordosis was restored in 10 of the 12 patients who underwent corpectomy, strut graft and plating. Motor power improved in all but two patients, who had radiculopathy. None of the patients had deterioration of neurology or neck pain at final follow-up.
Conclusion: Anterior corpectomy of the caudal vertebrae, strut graft and cervical spine plating obtained good cervical lordosis and neurological improvement in patients with late presentation of cervical spine dislocation, which did not reduce with initial skeletal traction. This approach is less challenging than those advocated by previous authors exposed to managing these injuries.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
None of the authors are receiving any financial benefit or support from any source.
