Reversal of Traumatic Pentaplegy after Combined C1–C2 Fracture

Czech version

Authors: R. Lukáš ¹; P. Barsa ²
Authors‘ workplace: Krajská nemocnice Liberec, a. s. Traumatologicko-ortopedické centrum ¹; Krajská nemocnice Liberec, a. s. Neurocentrum ²
Published in: Cesk Slov Neurol N 2012; 75/108(2): 240-243
Category: Case Report

Overview

Otherwise healthy 32-year-old man was found quadriplegic and without any signs of breathing at a site of his fall from a body of a truck. The diagnosis of three fragment Jefferson’s type fracture of atlas together with incidental type II fracture of the dens of C2 was made at an emergency unit were the mechanically ventilated patient was transported. MRI subsequently revealed C0–C3 spinal cord oedema. Surgical stabilization of the fracture of both uppermost cervical vertebras was postponed to the third day after the trauma due to the patient’s haemodynamic instability. The circulatory system instability was also the reason for selecting the anterior approach. A combination of anterolateral transarticular screws together with a single screw for direct osteosynthesis of the dens stabilized the C1–C2 complex. At day 10 of post-surgical passive physiotherapy, the patient began to interfere with the mechanical ventilation. Gradual reversal of neurological deficit continued, so that three weeks after the trauma, the patient developed a sufficient spontaneous breathing. Improving paraparesis allowed him to walk. The patient, walking just with a pathological gait stereotype, continued his functional treatment at a specialized rehabilitation institute eight weeks after the accident. This extremely positive outcome supports the use of a proactive and early surgical approach even in patients with complete spinal cord injury at the upper cervical levels.

Key words:
upper cervical spine injury – post-traumatic oedema of the spinal cord – stabilisation

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