Subacute Posttraumatic Ascending Myelopathy After Excessive Closed Reduction of Bilateral Cervical Facet Dislocation

Abstract

Subacute posttraumatic ascending myelopathy in the cervical spine is a very rare and life-threatening condition. The nonspecific pattern of clinical course and magnetic resonance imaging does not provide firm clues as to its pathogenesis. We report a case of subacute posttraumatic ascending myelopathy after bilateral cervical facet dislocation. The 57-year-old man had quadriparesis after sustaining a neck injury from a fall. Excessive closed reduction and manipulation of the cervical facet dislocation resulted in worsening motor power of his extremities. Urgent operation and decompression by an anterior approach offered slight improvement of the quadriparesis. However, 3 days after the surgery, myelopathic manifestations including respiratory difficulty became progressive. Magnetic resonance imaging revealed that myelopathy had ascended into the brain stem. He died from pneumonia because of long-term ventilator support for 2 months after the trauma. Excessive reduction may give rise to serious complications, especially subacute posttraumatic ascending myelopathy, in traumatic spinal cord injury.