Case report: A complete lower cervical fracture dislocation without permanent neurological impairment

TL;DR

A rare case of a complete lower cervical spine fracture without severe nerve damage was successfully treated with surgery.

Contribution

This case report highlights the successful surgical treatment of a rare 'lucky' cervical fracture dislocation without severe neurological impairment.

Findings

The patient showed no severe neurological symptoms despite a complete C7 fracture and dislocation.

Surgical intervention successfully restored function and relieved pain in the patient.

Two years post-surgery, partial sensory and muscle function had recovered.

Abstract

Complete fractures and dislocations of the lower cervical spine are usually associated with severe spinal cord injury. However, a very small number of patients do not have severe spinal cord injury symptoms, patients with normal muscle strength or only partial nerve root symptoms, known as “lucky fracture dislocation”. The diagnosis and treatment of such patients is very difficult. Recently, we successfully treated one such patient.

A 73-year-old male patient had multiple neck and body aches after trauma, but there was sensory movement in his limbs. However, preoperative cervical radiographs showed no significant abnormalities, and computed tomography (CT) and magnetic resonance imaging (MRI) confirmed complete fracture and dislocation of C7. Before operation, the halo frame was fixed traction, but the reduction was not successful. Finally, the fracture reduction and internal fixation were successfully performed by surgery. The postoperative pain of the patient was significantly relieved, and the sensory movement of the limbs was the same as before. Two years after surgery, the patient’s left little finger and ulnar forearm shallow sensation recovered, and the right flexion muscle strength basically returned to normal.

This case suggests that when patients with trauma are encountered in the clinic, they should be carefully examined, and the presence of cervical fracture and dislocation should not be ignored because of the absence of neurological symptoms or mild symptoms. In addition, positioning during handling and surgery should be particularly avoided to increase the risk of paralysis.

Figures