Management of Misdiagnosed Bilateral Cervical Facet Dislocation: A Case Report
Abstract
Background: Despite improvement in technology and decision-making, misdiagnosis or delayed diagnosis of cervical spine injuries in trauma patients can cause severe irreparable neurological damage.
Case Report: We present here a 56-year-old man, with a history of old bilateral C4-C5 dislocation who, contrarily to classically described unfavorable results of cranial traction in patients with older than 3 weeks cervical injury, underwent optimal reduction under cranial traction for four days and surgical intervention with an anterior surgical approach.
Conclusion: Relatively high incidence of missed cervical spine injuries in polytrauma patients illustrates that proper clinical examination, use of designed protocols for clearance of cervical trauma, and accurate interpretation of radiological imaging can sometimes be neglected.
1. Davis JW, Phreaner DL, Hoyt DB, Mackersie RC. The etiology of missed cervical spine injuries. J Trauma. 1993;34(3):342-6. doi: 10.1097/00005373-199303000-00006. [PubMed: 8483172].
2. Karamian BA, Schroeder GD, Holas M, Joaquim AF, Canseco JA, Rajasekaran S, et al. Variation in global treatment for subaxial cervical spine isolated unilateral facet fractures. Eur Spine J. 2021;30(6):1635-50. doi: 10.1007/s00586-021-06818-z. [PubMed: 33797624].
3. Anissipour AK, Agel J, Bellabarba C, Bransford RJ. Cervical facet dislocations in the adolescent population: A report of 21 cases at a level 1 trauma center from 2004 to 2014. Eur Spine J. 2017;26(4):1266-71. doi: 10.1007/s00586-017-5003-0. [PubMed: 28247075].
4. Koivikko MP, Myllynen P, Santavirta S. Fracture dislocations of the cervical spine: A review of 106 conservatively and operatively treated patients. Eur Spine J. 2004;13(7):610-6. doi: 10.1007/s00586-004-0688-2. [PubMed: 15300472]. [PubMed Central: PMC3476653].
5. Jain AK, Dhammi IK, Singh AP, Mishra P. Neglected traumatic dislocation of the subaxial cervical spine. J Bone Joint Surg Br. 2010;92(2):246-9. doi10.1302/0301-620X.92B2.22963. [PubMed: 20130317].
6. Gao W, Wang B, Hao D, Zhu Z, Guo H, Li H, et al. Surgical treatment of lower cervical fracture-dislocation with spinal
cord injuries by anterior approach: 5- to 15-year follow-up.
World Neurosurg. 2018;115:e137-e145. doi:
10.1016/j.wneu.2018.03.213. [PubMed: 29631085].
7. Nagata K, Inokuchi K, Chikuda H, Ishii K, Kobayashi A, Kanai H, et al. Early versus delayed reduction of cervical spine dislocation with complete motor paralysis: A multicenter study. Eur Spine J. 2017;26(4):1272-6. doi: 10.1007/s00586-017-5004-z. [PubMed: 28247074].
8. Sanchez B, Waxman K, Jones T, Conner S, Chung R, Becerra S. Cervical spine clearance in blunt trauma: Evaluation of a computed tomography-based protocol. J Trauma. 2005;59(1):179-83. doi: 10.1097/01.ta.0000171449.94650.81. [PubMed: 16096560].
9. Larson S, Delnat AU, Moore J. The Use of clinical cervical spine clearance in trauma patients: A literature review. J Emerg Nurs. 2018;44(4):368-74. doi: 10.1016/j.jen.2017.10.013. [PubMed: 29203049].
10. Gerrelts BD, Petersen EU, Mabry J, Petersen SR. Delayed diagnosis of cervical spine injuries. J Trauma. 1991;31(12):1622-6. doi: 10.1097/00005373-199112000-00010. [PubMed: 1749033].
11. Allen BL, Ferguson RL, Lehmann TR, O'Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976). 1982;7(1):1-27. doi: 10.1097/00007632-198200710-00001. [PubMed: 7071658].
12. Loughenbury P. Cervical spine fracture-dislocation. In: Giannoudis PV, editor. Fracture reduction and fixation techniques. New York, NY: Springer; 2020. p. 1-13.
13. Kanna RM, Shetty AP, Rajasekaran S. Modified anterior-only reduction and fixation for traumatic cervical facet dislocation (AO type C injuries). Eur Spine J. 2018;27(6):1447-53. doi: 10.1007/s00586-017-5430-y. [PubMed: 29279998].
14. Hassan MG. Treatment of old dislocations of the lower cervical spine. Int Orthop. 2002;26(5):263-7. doi: 10.1007/s00264-002-0350-8. [PubMed: 12378349]. [PubMed Central: PMC3620986].
15. Basu S, Malik FH, Ghosh JD, Tikoo A. Delayed presentation of cervical facet dislocations. J Orthop Surg (Hong Kong). 2011;19(3):331-5. doi: 10.1177/230949901101900314. [PubMed: 22184165].
2. Karamian BA, Schroeder GD, Holas M, Joaquim AF, Canseco JA, Rajasekaran S, et al. Variation in global treatment for subaxial cervical spine isolated unilateral facet fractures. Eur Spine J. 2021;30(6):1635-50. doi: 10.1007/s00586-021-06818-z. [PubMed: 33797624].
3. Anissipour AK, Agel J, Bellabarba C, Bransford RJ. Cervical facet dislocations in the adolescent population: A report of 21 cases at a level 1 trauma center from 2004 to 2014. Eur Spine J. 2017;26(4):1266-71. doi: 10.1007/s00586-017-5003-0. [PubMed: 28247075].
4. Koivikko MP, Myllynen P, Santavirta S. Fracture dislocations of the cervical spine: A review of 106 conservatively and operatively treated patients. Eur Spine J. 2004;13(7):610-6. doi: 10.1007/s00586-004-0688-2. [PubMed: 15300472]. [PubMed Central: PMC3476653].
5. Jain AK, Dhammi IK, Singh AP, Mishra P. Neglected traumatic dislocation of the subaxial cervical spine. J Bone Joint Surg Br. 2010;92(2):246-9. doi10.1302/0301-620X.92B2.22963. [PubMed: 20130317].
6. Gao W, Wang B, Hao D, Zhu Z, Guo H, Li H, et al. Surgical treatment of lower cervical fracture-dislocation with spinal
cord injuries by anterior approach: 5- to 15-year follow-up.
World Neurosurg. 2018;115:e137-e145. doi:
10.1016/j.wneu.2018.03.213. [PubMed: 29631085].
7. Nagata K, Inokuchi K, Chikuda H, Ishii K, Kobayashi A, Kanai H, et al. Early versus delayed reduction of cervical spine dislocation with complete motor paralysis: A multicenter study. Eur Spine J. 2017;26(4):1272-6. doi: 10.1007/s00586-017-5004-z. [PubMed: 28247074].
8. Sanchez B, Waxman K, Jones T, Conner S, Chung R, Becerra S. Cervical spine clearance in blunt trauma: Evaluation of a computed tomography-based protocol. J Trauma. 2005;59(1):179-83. doi: 10.1097/01.ta.0000171449.94650.81. [PubMed: 16096560].
9. Larson S, Delnat AU, Moore J. The Use of clinical cervical spine clearance in trauma patients: A literature review. J Emerg Nurs. 2018;44(4):368-74. doi: 10.1016/j.jen.2017.10.013. [PubMed: 29203049].
10. Gerrelts BD, Petersen EU, Mabry J, Petersen SR. Delayed diagnosis of cervical spine injuries. J Trauma. 1991;31(12):1622-6. doi: 10.1097/00005373-199112000-00010. [PubMed: 1749033].
11. Allen BL, Ferguson RL, Lehmann TR, O'Brien RP. A mechanistic classification of closed, indirect fractures and dislocations of the lower cervical spine. Spine (Phila Pa 1976). 1982;7(1):1-27. doi: 10.1097/00007632-198200710-00001. [PubMed: 7071658].
12. Loughenbury P. Cervical spine fracture-dislocation. In: Giannoudis PV, editor. Fracture reduction and fixation techniques. New York, NY: Springer; 2020. p. 1-13.
13. Kanna RM, Shetty AP, Rajasekaran S. Modified anterior-only reduction and fixation for traumatic cervical facet dislocation (AO type C injuries). Eur Spine J. 2018;27(6):1447-53. doi: 10.1007/s00586-017-5430-y. [PubMed: 29279998].
14. Hassan MG. Treatment of old dislocations of the lower cervical spine. Int Orthop. 2002;26(5):263-7. doi: 10.1007/s00264-002-0350-8. [PubMed: 12378349]. [PubMed Central: PMC3620986].
15. Basu S, Malik FH, Ghosh JD, Tikoo A. Delayed presentation of cervical facet dislocations. J Orthop Surg (Hong Kong). 2011;19(3):331-5. doi: 10.1177/230949901101900314. [PubMed: 22184165].
| Files | ||
| Issue | Vol 8, No 1 (2022) | |
| Section | Case Report | |
| DOI | https://doi.org/10.18502/jost.v8i1.9045 | |
| Keywords | ||
| Cervical Vertebrae Fracture Dislocation Neck Pain Traction | ||
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How to Cite
1.
Mehrabi Y, Vidal C, Mehrpour SR, Nabian MH. Management of Misdiagnosed Bilateral Cervical Facet Dislocation: A Case Report. J Orthop Spine Trauma. 2022;8(1):36-9.
