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Cervical cord transection secondary to C2-C3 dissociation

Richard Assaker1
,  
Georges El Hasbani2  
,  
Angel Rivera Castro1
,  
Menachem Gold1

1 Lincoln Medical and Mental Center, USA

2 American University of Beirut, Lebanon

Address correspondence to:

Georges El Hasbani

American University of Beirut,

Lebanon

Message to Corresponding Author


Article ID: 101005Z01RA2019

doi: 10.5348/101005Z01RA2019CL

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How to cite this article

Assaker R, El Hasbani G, Castra AR, Gold M. Cervical cord transection secondary to C2-C3 dissociation. Int J Case Rep Images 2019;10:101005Z01RA2019.

ABSTRACT

No Abstract

Keywords: Cervical cord transection, Subarachnoid hemorrhage, Pediatric population

Case Report

A 14-year-old previously healthy female was brought to the emergency department (ED) after being involved in a high speed motor vehicle accident. After resuscitation, a computed tomography (CT) scan brain revealed multifocal intraventricular and subarachnoid hemorrhage (Figure 1). CT scan of the cervical spine showed a traumatic spondylolisthesis at C2/C3 with posterior displacement of C3 vertebral body indicating a probable spinal cord injury at the C2/C3 level (Figure 2). MRI scan of the cervical spine showed a severe cervical central spinal canal stenosis with cord displacement and compression reflecting a combination of contusion and myelopathy (Figure 3). The patient was diagnosed with cervical cord transection due to C2- C3 dissociation. She underwent posterior arthrodesis extending from the occiput C1 to C1-2, C2-3, C4-5, C5-C6; using of an occipital place, lateral mass screws fixation under live fluoroscopy (Figure 4). Because of a surgical wound CSF leak, a lumbar drain was placed for one week. After two month as an inpatient, the patient was only able to move her facial muscles and had suffered from stage 2 bed ulcers. She was medically and hemodynamically stable, and was discharged to a traumatic brain injury facility.

Figure 1: Sagittal computed tomography scan Brain showing subarachnoid hemorrhage within the cisternal group as well as hemorrhage within the fourth ventricle (White arrow).

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Figure 2: Sagittal computed tomography scan of the cervical spine showing a traumatic spondylolisthesis at C2/C3 with posterior displacement of C3 vertebral body (White arrow).

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Figure 3: Sagittal T2 MRI section of the cervical spine showing a severe C3 level cervical cord compression associated with spinal cord edema extending superiorly to the cervicomedullary junction and inferiorly to the C4 level (Thin white arrow). There is disruption of the ligamentum flavum (Red arrow), of the posterior longitudinal ligament (Blue arrow), and of the anterior longitudinal ligament (Thick white arrowhead). Presence of a fluid collection is noted in the posterior epidural space at the level of C3 (Black arrow) that may reflect hyperacute hemorrhage or fluid related to tear of the longitudinal ligaments.

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Figure 4: Scout view of the cervical neck spine showing posterior arthrodesis of the cervical spine extending from the base of the occiput to C6.

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Discussion

The incidence of spinal injuries in children is between 2.7 and 9% of the total spinal injuries [1] with 40 to 60% occurring in the cervical spine [2]. The upper cervical area is the most commonly affected part in spinal injuries of the young children, while the thoracolumbar junctional injuries are more common in older children [3]. A history of trauma, including motor vehicle accident, should alert the attending clinician of an impending spinal injury. Pediatric spinal injury should always be suspected if a child presents to the ED with unconsciousness, torticollis, and neck pain/stiffness, temporary, or fixed neurological deficits [3]. Any pediatric patient who has tenderness, neurological deficit, loss of alertness, intoxication, or distracting painful injury is a candidate for cervical X-rays. Although CT scans may be superior to plain radiographs, they should not be used exclusively for cervical spine clearance because of the possibility of a ligamentous nature of the injury [4]. MRI is useful in children with persistent neurological symptoms. Surgery is usually indicated for unstable injuries. Anterior or posterior approach is best dictated by the column which is maximally disrupted [5].

Conclusion

We present the case of a 14 year old female who presented for cervical cord transection caused by a C2–C3 dissociation to be diagnosed by a cervical spine CT scan and confirmed by a cervical spine MRI. Pediatric spinal injury should be always suspected in a child presenting with neurologic deficits.

REFERENCES

1.

Ruge JR, Sinson GP, McLone DG, Cerullo LJ. Pediatric spinal injury: The very young. J Neurosurg 1988;68(1):25–30. [CrossRef] [Pubmed]   Back to citation no. 1  

2.

Hadley MN, Zabramski JM, Browner CM, Rekate H, Sonntag VK. Pediatric spinal trauma review of 122 cases of spinal cord and vertebral column injuries. J Neurosurg 1988;68(1):18–24. [CrossRef] [Pubmed]   Back to citation no. 1  

3.

Cirak B, Ziegfeld S, Knight VM, Chang D, Avellino AM, Paidas CN. Spinal injuries in children. J Pediatr Surg 2004;39(4):607–12. [CrossRef] [Pubmed]   Back to citation no. 1  

4.

Holmes JF, Akkinepalli R. Computed tomography versus plain radiography to screen for cervical spine injury: A meta-analysis. J Trauma 2005;58(5):902–5. [CrossRef] [Pubmed]   Back to citation no. 1  

5.

Stauffer ES, Kelly EG. Fracture dislocations of the cervical spine. Instability and recurrent deformity following treatment by anterior interbody fusion. J Bone Joit Surg Am 1977;59(1):45–8. [CrossRef] [Pubmed]   Back to citation no. 1  

SUPPORTING INFORMATION

Author Contributions

Richard Assaker - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Georges El Hasbani - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Angel Rivera Castro - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Menachem Gold - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Guaranter of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this clinical image.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2019 Richard Assaker et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.


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