C2–C3 spinal fracture subluxation with ligamentous and vascular injury: a case report and review of management

Spinal Cord Series and Cases, 2019 · DOI: 10.1038/s41394-019-0150-7 · Published: January 2, 2019

Simple Explanation

Spinal cord injuries, particularly high cervical spine injuries, can lead to paralysis or death due to damage to ligaments, blood vessels, and the spinal cord itself. Currently, there's no standard treatment plan for these complex injuries. This paper presents a case of a 29-year-old patient who suffered a severe neck injury, including a broken and dislocated spine, torn ligaments, and a damaged vertebral artery, after a high-speed accident. The doctors reviewed existing studies to understand the injury patterns, complications, and outcomes of similar neck injuries. The patient underwent surgery to realign and stabilize the spine, and regained some movement through rehabilitation. Treating these injuries requires careful attention to all the damaged components.

Study Duration

Not specified

Participants

A 29-year-old polytrauma patient

Evidence Level

Case Report

Key Findings

1
The patient had a C2–C3 fracture subluxation with complete ligamentous dissociation and vertebral artery dissection.
2
The patient underwent an open anterior C2–C3 reduction and discectomy with fusion and plating, followed by a C2–C4 posterior instrumented fusion.
3
The patient regained some motor function postoperatively and through rehabilitation, highlighting the potential for recovery with early intervention.

Research Summary

This case report describes a 29-year-old polytrauma patient with a severe C2–C3 spinal fracture subluxation, ligamentous disruption, and vertebral artery injury. The lack of a unifying algorithm to guide treatment decisions highlights the variations in pathology and subsequent limitations in generalizability of current literature. The patient underwent surgical intervention involving anterior and posterior fusion, and regained some motor function through rehabilitation. Early intervention was deemed critical to stabilize the joint and prevent secondary insults. The authors reviewed existing literature on subaxial cervical spine injuries, associated complications, and neurological outcomes, emphasizing the importance of considering all injury components when making treatment decisions. Algorithmic management of subaxial spinal injury is mainly driven by the SLIC grading system, however speciﬁc operative approaches are still mainly driven by surgeon preference.

Practical Implications

Surgical Approach

The case demonstrates that a combined anterior and posterior approach can be effective in stabilizing complex subaxial cervical spine injuries.

Early Intervention

Early surgical intervention can improve neurologic and medical outcomes in patients with severe spinal cord injuries.

Comprehensive Assessment

Careful consideration of all injury components, including ligamentous, vascular, and neurological damage, is crucial for effective treatment planning.

Study Limitations

1
Single case report limits generalizability
2
Lack of a unifying treatment algorithm for subaxial spinal injuries
3
Variations in surgical approach depending on extent of injury and surgeon experience

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