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Delayed Sub-axial Fracture Dislocation Surgical Management: Technical Notes and Review of the Literature
Fahad Alhelal1,2,3, Suhail AlAssiri1,2,3, Sami I Aleissa1,2,3
1Orthopaedic Surgery, King Abdulaziz Medical City Riyadh, Riyadh, SAU.
Cureus
|June 27, 2023
Summary
Delayed sub-axial cervical spine fracture-dislocation in an obese patient was successfully treated with traction and a single posterior approach. This case highlights effective management for complex spinal injuries.
Area of Science:
- Orthopedics
- Neurosurgery
- Spinal Surgery
Background:
- Delayed, unstable sub-axial cervical spine injuries present surgical challenges with no consensus on optimal treatment.
- Obesity is a complicating factor in managing spinal trauma.
Observation:
- A 35-year-old obese woman with a BMI of 30.1 sustained a C6-C7 fracture-dislocation and C1-C2 instability after a motor vehicle accident.
- Initial assessment revealed complete quadriplegia (ASIA A), vertebral artery attenuation, and multiple cervical spine fractures.
Findings:
- The patient underwent three weeks of pre-operative traction followed by a single posterior surgical approach for reduction and instrumentation.
- A novel technique utilizing pedicle screws and tension-band wiring achieved successful reduction and stabilization.
Implications:
- This case demonstrates the efficacy of prolonged pre-operative traction and a single-approach technique in managing complex delayed cervical spine injuries.
- The findings suggest that a well-planned posterior-only approach can be a viable option for selected cases of delayed cervical fracture-dislocation, even in obese patients.
