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Dislocations at the cervicothoracic junction.

D K Evans

    The Journal of Bone and Joint Surgery. British Volume
    |March 1, 1983
    PubMed
    Summary
    This summary is machine-generated.

    Cervicothoracic junction dislocations are often missed, with most patients misdiagnosed on admission. Operative reduction is recommended for pure dislocations only if the spinal cord lesion is incomplete and surgery is timely.

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    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.

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  • 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.