DefinePK

Abstract

A 29 year old woman during a non-professional, recreational, wrestling episode sustained a fall on her neck. She immediately experienced severe neck pain and felt weakness in her upper limbs. Her neurological examination in the emergency department, showed grade 3/5 motor strength in deltoid, biceps, brachioradialis, wrist and finger extensors bilaterally. The sensations were bilaterally decreased in the distribution of C5, 6 and 7 along with a diminished biceps and brachioradialis reflex. Lower limb examination was normal. Bladder and bowel function was found to be intact. Cervical spine X-rays showed that she had a complete facet dislocation at C4-5 level. She was immediately placed into halo traction and an attempt at closed reduction was made. Starting from 20 pounds of traction, weights were sequentially increased. Periodic neurologic and radiographic examination was performed by a physician during this period. The reduction was achieved at 80 pounds of weight. After reduction she underwent an MRI to rule out any disc protrusion or extrusion in the spinal canal. She underwent an anterior cervical disectomy and fusion with bone graft from the iliac crest. Instrumentation was performed using anterior cervical locking plate. She made a complete neurological recovery in 5 weeks and at 12 months follow up she was back to her activities of daily living. [(0)] Figure 1. X-ray cervical spine, lateral view, (A) Facet dislocation at C4-5, (B) No reduction on 45 lbs of traction (C) At 80 pounds of traction, reduction was achieved. Mild over distraction can be seen at C4-5 disc level. Weights were reduced to 15 pounds once reduction was achieved.   [(1)] Figure 2. MRI cervical spine (Post reduction) shows injury at C4-5 level . Small disc protrusion can be seen at the same level (compare with adjacent levels) but no extruded disc fragment could be seen.   [(2)] Figure 3. Postoperative X-rays (A) lateral view (B) AP view showing the reduced position of C4-5 facets and fusion with autograft. An anterior cervical locking plate can be seen in position.