Failure to Recognize Traumatic Cervical Spinal Instability, C7-T1 Traumatic Cervical Spine Deformity
The patient is a 72-year-old male who suffered C7 and T1 fractures status post a motor vehicle accident. He is neurologically intact on presentation to an outside emergency department and is initially managed with a hard cervical collar. He presented to our clinic 2 months after the initial injury with worsening neck deformity and new right hand weakness and numbness.
- Limited range of motion in the cervical spine
- Chin on chest deformity
- Neck pain with movement
- Right C8-T1 numbness, otherwise intact to light touch throughout
- Right hand grip weakness 4/5, otherwise full strength throughout
- Reflexes 2+ throughout
- No upper motor neuron signs
The patient was was kept in hard cervical collar for 2 months.
The initial cervical spine CT showed C7 tear drop and T1 superior endplate fractures, left C7 pedicle fracture and right C7 facet fracture (Figures 1A, 1B, and 1C, below).
Figures 2A and 2B (below) show sagittal and axial CT views of the cervical spine (8 weeks after the initial trauma), and reveal significant kyphotic deformity with T1 compression fracture and significant loss of height.
C7-T1 compression fractures with kyphotic deformity.
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Staged Anterior Corpectomy and Posterior Instrumented Fusion
- Anterior C7-T1 corpectomy with expandable cage and anterior C6-T1 plate
- Posterior C3-T4 segmental screw instrumentation with rod placement C3-T4 with autograft and allograft C3-T4
The right C8 nerve root was significantly compressed.
Postoperative AP (Figure 3A), lateral radiograph of the cervical spine (Figure 3B), and Swimmer's view (Figure 3C). The imaging demonstrates successful reduction of the kyphotic deformity and restoring the cervical sagittal alignment.
The patient had swallowing difficulty in the immediate postoperative period that improved upon discharge. At 6 month follow-up, the patient's right hand weakness improved to full strength.
The author presents an interesting case of a patient with a delayed diagnosis of a traumatic cervicothoracic fracture. This is a highly challenging case from a management standpoint given the deformity that developed and the complexity of obtaining circumferential access to this region.
The surgical algorithm provided adequate neural decompression, deformity correction and 360-degree stabilization. The radiographic and clinical outcome is impressive and was obtained with minimal patient morbidity. Kudos to Dr. Khalil in his treatment of this challenging case.