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Case 16-1: Recovery from a severe cervical spine injury

Patient Presentation

A 19-year-old dove into a shallow lake.

Figure 16-1.

Cervical spine x-ray before reduction. WA = severe compromise of the spinal canal diameter from a fracture/dislocation of the C3-C4 vertebra

Reproduced with permission from Brunette DD, Rockswold GL. Neurologic recovery following rapid spinal realignment for complete cervical spinal cord injury, J Trauma 1987 Apr;27(4):445-447.

Figure 16-2.

Cervical spine x-ray post-reduction. WA = normal spinal canal diameter as a result of the reduction

Reproduced with permission from Brunette DD, Rockswold GL. Neurologic recovery following rapid spinal realignment for complete cervical spinal cord injury, J Trauma 1987 Apr;27(4):445-447.

Clinical Features

The patient was in mild painful distress. He was awake, alert and oriented with significant motor and sensory deficits. The patient had no sensation below the C4 level. He had no rectal tone and had priapism. His only motor function was an inconsistent flicker of movement in one of his feet.

Differential Dx

  • Cervical spinal cord injury, including fracture, dislocation, or vascular injury

Emergency Care

An initial lateral cervical spine radiograph demonstrated a fracture/dislocation at the C3-C4 level. Marked narrowing of the width of his spinal canal was evident. The patient was lightly sedated, Gardner-Wells cervical tongs were placed, and a series of increasing weights were applied as traction. Within 90 minutes from injury, reduction of the fracture/dislocation was obtained with a markedly increased spinal canal diameter.

Outcome

Shortly after reduction, the patient began to regain sensory and motor function in a symmetrical pattern, starting with his lower extremities. He had a complete recovery of neurologic function.

Key Learning Points

  • The published case report for this patient gives additional details (see the first reference under Further Reading).

  • Early decompression of the cervical spinal cord appears to improve neurologic outcome.

Further Reading

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Battistuzzo  CR, Armstrong  A, Clark  J,  et al. Early decompression following cervical spinal cord injury: examining the process of care from accident scene to surgery. J Neurotrauma. 2016;33(12):1161–1169.  [PubMed: 26650510]
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Brunette  DD, Rockswold  GL. Neurologic recovery following rapid spinal realignment for complete cervical spinal cord injury. J Trauma. 1987;27(4):445–447.  [PubMed: 3573096]
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Evaniew  N, Noonan  VK, Fallah  N,  et al. Methylprednisolone for the treatment of patients with acute spinal cord injuries: a propensity score-matched cohort study from a canadian multi-center spinal cord injury registry. J Neurotrauma. 2015;32(21):1674–1683.  [PubMed: 26065706]
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Li  Y, Walker  CL, Zhang  YP, Shields  CB, Xu  XM. Surgical decompression in acute spinal ...

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