J Korean Soc Spine Surg.  2004 Mar;11(1):61-65. 10.4184/jkss.2004.11.1.61.

A Case Report of Missed Cervicothoracic Fracture-Dislocation in Plain Radiographs

• Park WW
• Ahn SJ
• Hwang WJ

• KMID: 2003193
• DOI: http://doi.org/10.4184/jkss.2004.11.1.61

Abstract

A complete fracture dislocation at the cervicothoracic junction is rare and accompanied by severe spinal cord injury. This region is difficult to image with plain radiography, and to immobilize with external orthosis due to the biomechanical forces exerted in this transitional portion of the spinal column. We experienced a rare case in 52-year-old male victim of a car accident. He sustained paraplegia, and complained of dyspnea and neck pain of 10 days duration at another hospital. The delayed clinical rediagnosis was a C6 and 7 spinous process fracture and a cervicothoracic fracture dislocation, with complete transection of spinal cord, which was based on a clinical examination, simple radiography, CT and MRI. Skeletal traction was immediately applied, followed by a posterior pedicle screw to stabilize the spine and secure the grafts. Rehabilitation was initiated and the dysphagia and dyspnea, due to aspiration pneumonia, were improved, but no neurologic recovery was made after the 1st postoperative year.

Keyword

Thoracocervical spine; Fracture and Dislocation; Surgical treatment; Transpedicular screw

MeSH Terms

Deglutition Disorders
Dislocations
Dyspnea
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Neck Pain
Orthotic Devices
Paraplegia
Pneumonia, Aspiration
Radiography
Rehabilitation
Spinal Cord
Spinal Cord Injuries
Spine
Traction
Transplants

Figure

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  Fig. 1. (A) Initial plain radiograph does not show image of thoracocervical junction. (B) MRI shows cervicothoracice fracture-dislo-cation with complete transection of spinal cord.

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  Fig. 2. Postskeletal tractional plain radiograph shows unsatis-factory reduction.

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  Fig. 3. Radiograph of Posttranspedicular fixation of C7-T2 shows satisfactory reduction and alignment.

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