Delayed Sub-axial Fracture Dislocation Surgical Management: Technical Notes and Review of the Literature

This case report describes the successful surgical management of a delayed sub-axial cervical spine fracture-dislocation in a 35-year-old woman. The patient sustained the injury in a motor vehicle accident and presented three weeks later with complete quadriplegia. The surgical approach involved pre-operative traction followed by a single-surgery, single-approach technique using pedicle screws and tension-band wiring. The delayed nature of the presentation made the surgical reduction challenging. The technique used aimed to achieve a reasonable reduction and stable cervical spine to expedite the patient’s mobility and rehabilitation, all in a single procedure. Despite successful anatomical reduction and stabilization, the patient did not regain any power or sensation. However, she was clinically stable enough to start a spinal cord injury rehabilitation program.

• 1
  A novel single-surgery, single-approach technique with pedicle screws and tension-band wiring can be successfully used for delayed sub-axial fracture-dislocation.
• 2
  Sufficient duration of pre-operative traction is essential for achieving proper reduction in delayed cervical spine fracture-dislocation.
• 3
  Even with successful anatomical reduction, neurological recovery may not occur in patients with complete quadriplegia resulting from delayed presentation.