ABSTRACT
INTRODUCTION: Multiple cervical spine fractures are a relatively infrequent entity and thus the available information on them is scarce worldwide. The cases reported are usually managed conservatively, with a combination of skeletal traction and various braces, with variable results. There are only a few reports of multiple fractures treated surgically. Objective: This is a report of a clinical case of a multiple cervical fracture treated surgically in 2 stages at the Mexico City Center for Patients with Spine and Spinal Cord Injury (Centro de Atenci6n a Lesionados Raquimedulares de la Ciudad de Mexico), located at "La Villa" General Hospital, SSDF. MATERIAL AND METHODS: We report the clinical case of a male, 46 year-old patient involved in a motor vehicle accident who sustained spine and spinal cord injuries consisting of ASIA C C2-C6 fractures. It was decided to perform two-stage surgery with posterior and anterior instrumentation. We report the 19-month clinical and radiological follow-up. RESULTS: In the 19-month follow-up visit, the patient was found to be ASIA D according to the neurological assessment, with mild motor deficit of the left thoracic limb. The patient had returned to his usual job and had acceptable cervical spine mobility. CONCLUSIONS: The patient's appropriate course from the neurological perspective and his return to his daily activities leads to recommending the surgical management of multiple fractures, customizing it in each case according to the fractures' characteristics. Favorable results may be expected from this approach.
Subject(s)
Multiple Trauma , Spinal Fractures , Humans , Male , Middle Aged , Multiple Trauma/diagnostic imaging , Multiple Trauma/surgery , Radiography , Spinal Fractures/diagnostic imaging , Spinal Fractures/surgeryABSTRACT
BACKGROUND: Knowledge of the morphometric anatomy of cervical pedicles is essential for the safe and accurate placement of pedicle screws during instrumentation of the cervical spine. Screw placement in the lumbar and thoracic vertebrae is considered as a safe practice, unlike the cervical vertebrae due to the risks involved. There are few reports on this technique. The little available information comes from populations different from the Mexican population. Knowing the measurements of each cervical vertebra will provide proper screw orientation and selection at the time of screw placement. METHODS: Prospective, cross-sectional, descriptive study in subjects who presented at the outpatient and emergency services. Patient's in whom a CAT scan of the cervical spine was ordered as part of the work-up protocol, from April 1st 2010 to October 31st 2010, were included. A morphometric anatomic study was undertaken using the CAT software. In a saggital view: a) Saggital angle, b) Saggital diameter. In an axial view: a) Work distance, b) Cross-sectional angle and c) Cross-sectional diameter. RESULTS: The following measurements were obtained for each segment from C2 to C7: mean, standard deviation, range and minimal and maximal values. CONCLUSIONS AND CLINICAL RELEVANCE: Appropriate preoperative planning prior to cervical transpedicular instrumentation is essential to achieve greater accuracy during screw placement. The information obtained allows performing the procedure. As a result of this, a report based on out center's experience may be disseminated thus sharing our technique with the medical community.
