A rare case of complete C2–C3 dislocation with mild neurological symptoms

Abstract

The authors report a rare case of complete C2–C3 dislocation with unexpectedly mild neurological symptoms in a 57 year old man involved in a motor vehicle accident, who had previously undergone posterior laminectomy from C3 through C7. A retrospective chart analysis and a thorough radiographic review were performed. X-rays and CT of the cervical spine demonstrated a complete dislocation at the C2–C3 level. Computed tomographic angiography revealed disruption of both vertebral arteries; however, blood flow was evident in the basilar artery. After radiologically guided placement in cervical traction with tongs that reduced the subluxation by approximately 50% the patient had spontaneous eye opening and was able to follow commands. A two-stage 360o stabilization and fusion was performed and the patient was finally discharged 24 days after admission with his neurological status essentially unchanged. In conclusion, our patient presented with surprisingly mild neurological symptoms. The previously performed laminectomy could have both predisposed to injury as well as protected his spinal cord from potentially fatal trauma.

Management of Traumatic Cervical Spondyloptosis in a Neurologically Intact Patient

“…The patient was reduced with cervical traction without incident and then underwent anterior-posterior stabilization. 1,14 Finally, in a presentation most similar to ours, Shah and Rajshekhar report a traumatic C7-T1 spondyloptosis with mild quadraparesis. Similar to our case, the patient had fractures of C5, C6, and C7 lamina, which prevented dorsal compression of the spinal cord.…”

Anterior discectomy/corpectomy and fusion with internal fixation for the treatment of unstable hangman's fractures: a retrospective study of 38 cases

“…7,24 The symptoms and neurological signs may not correlate with the degree of bone injury. 20 Fountas et al 9 reported that the diameter of the cervical spinal cord is 15%-20% smaller than the diameter reported based on autopsy studies and considered that this relatively small diameter made the spinal cord less susceptible to injury by compression. This is probably the reason for the minor neurological deficits observed in our cases, together with auto decompression of the spinal canal.…”

‘Split and splayed C3’—traumatic lateral C2–3 dislocation without neurological deficits: unique case and its management

“…However, the junction of these forms a unique zone of C2 and C3. Traumatic C2-3 dislocation is usually seen in the sagittal plane and is often associated with C2 pars interarticularis fracture [1][2][3]5]. This sagittal C2-3 dislocation can be translational or angular.…”

“…The traumatic C2-3 dislocations, including complete subluxation, have been described in the antero-posterior plane [1]. These have been classified further based on the stability and fracture morphology.…”