REPRESENTATIVE CASES

A 36 year old male presented with persistent neck pain following a road traffic accident. A month later he started developing stiffness of all 4 limbs. The x-ray of the cervical spine was reported as normal. The MRI scan showed a C7-T1 total dislocation with pressure on the cord from both anterior and posterior.

He was operated in a single stage anesthesia. Under skull traction, a posterior approach was first utilized to release the facets at C7-T1. The posterior elements of T1 were found to be floating and these were removed. The patient was then turned supine and through a classical anterior cervical approach and a trans-clavicular trans-sternal extention, corpectomy of T1 was done along with discectomy of the adjacent levels. The gap was bridged by a tricorticate bone graft, and stabilization was performed using an anterior monocortical locking cervical plating system. The patient was once again turned prone and a posterior fusion and stabilization was done using Hartshill rectangle and wires. Thus the spinal cord was decompressed and a 3600 stabilisation was done .

The patient was mobilized on the 8th postoperative day and was discharged without any fresh deficits. The patient is asymptomatic at one year follow up and the radiology is showing good fusion and proper implant position.

Cervico-thoracic dislocations are notorious for being missed as the region is poorly visualized on plain lateral radiographs. Persistent pain or the development of neurological deficit is often the only indicator of a pathology, unless carefully looked for in the AP radiograph. The MR scans will clearly delineate these dislocations which may be complete with spondyloptosis. These patients require careful handling, as the region is difficult to immobilize even with skull traction. In most instances reduction does not take place and it is necessary to decompress the cord and stabilise the spine from both anterior and posterior.