Dislocations at the cervicothoracic junction.

Area of Science:

• Orthopedics
• Neurosurgery
• Traumatology

Background:

• Cervicothoracic junction dislocations are rare and frequently missed injuries.
• Nearly two-thirds of these injuries were not diagnosed correctly upon admission in a 27-year study.
• This highlights a significant diagnostic challenge in spinal trauma.

Purpose of the Study:

• To analyze the diagnosis and management of cervicothoracic junction dislocations.
• To evaluate the outcomes of conservative and operative treatments for these injuries.
• To determine the indications for surgical intervention.

Main Methods:

• Retrospective review of 14 cases of cervicothoracic junction dislocations over 27 years.
• Analysis of diagnostic accuracy on admission.
• Assessment of treatment methods (conservative vs. open reduction) and neurological outcomes.

Main Results:

• Two-thirds of dislocations were missed on initial diagnosis.
• Only two dislocations, associated with posterior bony element fractures, were reduced conservatively.
• Open reduction was necessary for pure C7-T1 dislocations.
• Spinal cord lesion severity was not influenced by dislocation reduction.
• Patients with incomplete spinal cord lesions showed excellent neurological recovery regardless of reduction.

Conclusions:

• Operative reduction of cervicothoracic junction dislocations is indicated only for pure dislocations when the spinal cord lesion is incomplete, allowing for potential nerve root recovery.
• Timely surgical intervention is crucial for optimizing outcomes.
• Conservative treatment is generally ineffective for pure dislocations at this level.