A Case Report of Missed Cervicothoracic Fracture-Dislocation in Plain Radiographs

Weon Wook Park; Seong Jun Ahn; Won Jun Hwang

doi:10.4184/jkss.2004.11.1.61

Journal List > J Korean Soc Spine Surg > v.11(1) > 1035641

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Park, Ahn, and Hwang: A Case Report of Missed Cervicothoracic Fracture-Dislocation in Plain Radiographs

Original Article

Journal of Korean Spine Surg 2004;11(1):61-65.

Published online: 21 February 2004

DOI: https://doi.org/10.4184/jkss.2004.11.1.61

A Case Report of Missed Cervicothoracic Fracture-Dislocation in Plain Radiographs

Weon Wook Park, M.D., Seong Jun Ahn, M.D.^#, Won Jun Hwang, M.D.^#

Department of Orthopaedic Surgery, Centum Hospital, Pusan, Korea

^#Department of Orthopedic Surgery, Daedong Hospital, Pusan, Korea

Address reprint requests to Seong Jun Ahn, M.D. Department of Orthopedic Surgery, Dae Dong Hospital # 530-1 Meng Lun-1 dong, Dong Rae-gu, Pusan, Korea Tel: 82-51-554-8996, Fax: 82-51-553-7575, E-mail: AHNSJOSDEPT@lycos.co.kr

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A complete fracture dislocation at the cervicothoracic junction is rare and accompanied by severe spinal cord injury. This region is difficult to image with plain radiography, and to immobilize with external orthosis due to the biomechanical forces exerted in this transitional portion of the spinal column.

We experienced a rare case in 52- year- old male victim of a car accident. He sustained paraplegia, and complained of dyspnea and neck pain of 10 days duration at another hospital. The delayed clinical rediagnosis was a C6 and 7 spinous process fracture and a cervicothoracic fracture dislocation, with complete transection of spinal cord, which was based on a clinical examination, simple radiography, CT and MRI.

Skeletal traction was immediately applied, followed by a posterior pedicle screw to stabilize the spine and secure the grafts. Rehabilitation was initiated and the dysphagia and dyspnea, due to aspiration pneumonia, were improved, but no neurologic recovery was made after the 1st postoperative year.

Keywords: Thoracocervical spine, Fracture and Dislocation, Surgical treatment, Transpedicular screw

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Fig. 1.

(A) Initial plain radiograph does not show image of thoracocervical junction. (B) MRI shows cervicothoracice fracture-dislo-cation with complete transection of spinal cord.

Fig. 2.

Postskeletal tractional plain radiograph shows unsatis-factory reduction.

Fig. 3.

Radiograph of Posttranspedicular fixation of C7-T2 shows satisfactory reduction and alignment.

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