Lower Cervical Spine Fractures and Dislocations

EXAMPLE 3 (continued)

BILATERAL CERVICAL FACET FRACTURE DISLOCATION

MRI examination

Surgery for Open reduction and fusion advised

Plan for posterior +/- anterior depending on technique

He refuses surgery

Spine unstable and dislocated

Agrees to try traction

TRACTION PROTOCOL:

Direction and Weights Force - 2.5 kg for head and 0.5 kg for each vertebra

Direction Neutral In line with Auditory meatus

Technique to reduce locked facets flexion first then extension once reduced

Up to 20kg can be used

Neurology must be closely monitored

Flexion needed - raise pulley

Extension needed – support under shoulders

Faced with 3-6 months in halo body jacket and 4 limb numbness / weakness he finally agrees to surgery

CORD MYELOMALACIA

Post reduction CT and MRI also showing problems at adjacent level with degenerative spondylosis with osteophytes and degenerated disc with cord impingement.

Surgical Plan: 2 level decompression and fusion

Post operative progress:

After 6 months of rehabilitation he was able to walk unaided, there was residual clumsiness of the lower limbs.

POST REDUCTION LATERAL C SPINE X RAYS

SPINE CARE HONG KONG

ACCURATE DIAGNOSIS, STRUCTURED TREATMENT