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Article: Traumatic fracture-dislocation of C5 on C6 through a previously solid multilevel anterior cervical discectomy and fusion: A case report and review of the literature

TitleTraumatic fracture-dislocation of C5 on C6 through a previously solid multilevel anterior cervical discectomy and fusion: A case report and review of the literature
Authors
KeywordsAnterior cervical discectomy
Cervical spine
Fracture
Fracture-dislocation
Fusion
Internal fixation
Osteoporosis
Trauma
Issue Date2006
PublisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/spinee
Citation
Spine Journal, 2006, v. 6 n. 1, p. 55-60 How to Cite?
AbstractBackground context: Due to the underlying pathology and altered biomechanics, traumatic cervical fractures have been reported in patients with ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH), ossification of the posterior longitudinal ligament (OPLL), and combination of DISH and OPLL. However, incidence of a fracture-dislocation through a solid multilevel anterior cervical discectomy and fusion (ACDF) construct with no associated underlying pathology of AS, DISH, or OPLL but severe osteopenia has not, to the best knowledge of the authors, been reported in the medical literature. Purpose: To report the development of an unstable cervical spine fracture that occurred through a previous multilevel anterior cervical fusion and the challenges associated with the diagnosis and surgical management of these uncommon lesions. Study design/setting: A case report and review of the literature. Methods: A case report entailing the clinical history, operative management, and postoperative course of a 72-year-old male patient with no known AS, DISH, or OPLL who suffered a cervical spine fracture-dislocation, secondary to a motor vehicle accident, through a previous solid three-level ACDF that was performed 20 years earlier. Results: The patient underwent emergent reduction and realignment of the cervical fracture-dislocation, eventual posterior spinal fusion and stabilization with rigid segmental internal fixation, and application of external halo immobilization. At recent follow-up, he has radiographic evidence of fusion and maintenance of sagittal alignment without loss of reduction. Conclusions: Multilevel cervical fusion constructs are susceptible to traumatic injuries. Many of the same challenges in the management of the previously fused ACDF patient, who sustains a fracture-dislocation, are similar to those found in the patient with mass-inflammatory conditions or metabolic disorders, such as AS, DISH, or OPLL. In many cases, this includes severe osteopenia, long unstable fusion segments, and difficulties associated with prolonged halo vest immobilization. As a result, preoperative surgical planning should take into consideration the difficulties in achieving fracture reduction, decompression, and proper stabilization. © 2006 Elsevier Inc. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/92942
ISSN
2015 Impact Factor: 2.66
2015 SCImago Journal Rankings: 1.153
References

 

DC FieldValueLanguage
dc.contributor.authorOrndorff, DGen_HK
dc.contributor.authorSamartzis, Den_HK
dc.contributor.authorWhitehill, Ren_HK
dc.contributor.authorShen, FHen_HK
dc.date.accessioned2010-09-22T05:04:28Z-
dc.date.available2010-09-22T05:04:28Z-
dc.date.issued2006en_HK
dc.identifier.citationSpine Journal, 2006, v. 6 n. 1, p. 55-60en_HK
dc.identifier.issn1529-9430en_HK
dc.identifier.urihttp://hdl.handle.net/10722/92942-
dc.description.abstractBackground context: Due to the underlying pathology and altered biomechanics, traumatic cervical fractures have been reported in patients with ankylosing spondylitis (AS), diffuse idiopathic skeletal hyperostosis (DISH), ossification of the posterior longitudinal ligament (OPLL), and combination of DISH and OPLL. However, incidence of a fracture-dislocation through a solid multilevel anterior cervical discectomy and fusion (ACDF) construct with no associated underlying pathology of AS, DISH, or OPLL but severe osteopenia has not, to the best knowledge of the authors, been reported in the medical literature. Purpose: To report the development of an unstable cervical spine fracture that occurred through a previous multilevel anterior cervical fusion and the challenges associated with the diagnosis and surgical management of these uncommon lesions. Study design/setting: A case report and review of the literature. Methods: A case report entailing the clinical history, operative management, and postoperative course of a 72-year-old male patient with no known AS, DISH, or OPLL who suffered a cervical spine fracture-dislocation, secondary to a motor vehicle accident, through a previous solid three-level ACDF that was performed 20 years earlier. Results: The patient underwent emergent reduction and realignment of the cervical fracture-dislocation, eventual posterior spinal fusion and stabilization with rigid segmental internal fixation, and application of external halo immobilization. At recent follow-up, he has radiographic evidence of fusion and maintenance of sagittal alignment without loss of reduction. Conclusions: Multilevel cervical fusion constructs are susceptible to traumatic injuries. Many of the same challenges in the management of the previously fused ACDF patient, who sustains a fracture-dislocation, are similar to those found in the patient with mass-inflammatory conditions or metabolic disorders, such as AS, DISH, or OPLL. In many cases, this includes severe osteopenia, long unstable fusion segments, and difficulties associated with prolonged halo vest immobilization. As a result, preoperative surgical planning should take into consideration the difficulties in achieving fracture reduction, decompression, and proper stabilization. © 2006 Elsevier Inc. All rights reserved.en_HK
dc.languageengen_HK
dc.publisherElsevier BV. The Journal's web site is located at http://www.elsevier.com/locate/spineeen_HK
dc.relation.ispartofSpine Journalen_HK
dc.subjectAnterior cervical discectomyen_HK
dc.subjectCervical spineen_HK
dc.subjectFractureen_HK
dc.subjectFracture-dislocationen_HK
dc.subjectFusionen_HK
dc.subjectInternal fixationen_HK
dc.subjectOsteoporosisen_HK
dc.subjectTraumaen_HK
dc.titleTraumatic fracture-dislocation of C5 on C6 through a previously solid multilevel anterior cervical discectomy and fusion: A case report and review of the literatureen_HK
dc.typeArticleen_HK
dc.identifier.emailSamartzis, D:dspine@hku.hken_HK
dc.identifier.authoritySamartzis, D=rp01430en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/j.spinee.2005.06.014en_HK
dc.identifier.pmid16413449-
dc.identifier.scopuseid_2-s2.0-30544441595en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-30544441595&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume6en_HK
dc.identifier.issue1en_HK
dc.identifier.spage55en_HK
dc.identifier.epage60en_HK
dc.publisher.placeNetherlandsen_HK
dc.identifier.scopusauthoridOrndorff, DG=11241291500en_HK
dc.identifier.scopusauthoridSamartzis, D=34572771100en_HK
dc.identifier.scopusauthoridWhitehill, R=7003977321en_HK
dc.identifier.scopusauthoridShen, FH=7201583245en_HK

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