Traumatic Cervical Cord Transection without Facet Dislocations-A Proposal of Combined Hyperflexion-Hyperextension Mechanism: A Case Report

Abstract

A patient is presented with a cervical spinal cord transection which occurred after a motor vehicle accident in which the air bag deployed and the seat belt was not in use. The patient had complete quadriplegia below the C5 level and his imaging study showed cervical cord transection at the level of the C5/6 disc space with C5, C6 vertebral bodies and laminar fractures. He underwent a C5 laminectomy and a C4-7 posterior fusion with lateral mass screw fixation. Previous reports have described central cord syndromes occurring in hyperextension injuries, but in adults, acute spinal cord transections have only developed after fracture-dislocations of the spine. A case involving a post-traumatic spinal cord transection without any evidence of radiologic facet dislocations is reported. Also, we propose a combined hyperflexion-hyperextension mechanism to explain this type of injury.

Bridging the gap: Spinal cord fusion as a treatment of chronic spinal cord injury

“…In man, no recovery follows spinal cord transection (SCT) at whatever level as seen, for example, after stab wounds. [26,74,77,105,112,117] When the transection is partial, recovery is possible: 66% of 450 patients with stab wounds could eventually walk without or with only minimal help in one series and over half of 217 patients returned to their former occupation, usually within 6 months of the injury, in another. [4,84] Brown-Sequard types of lesion (i.e., hemisections) also recover: for instance, two patients with cervical hemisection recovered walking at 10 and 2 years[35] and another recovered almost completely at 3 years.…”

Traumatic cervical spinal cord transection

“…No reports of traumatic spinal cord transections in adults without fracture dislocation injuries in the sub axial spine are presented. 3 In our case, no evidence of fracture dislocation or subluxation on CT and MR was mandatory to assess cord injury that would explain patient symptoms.…”

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“…In man, no recovery follows spinal cord transection (SCT) at whatever level as seen, for example, after stab wounds. [26,74,77,105,112,117] When the transection is partial, recovery is possible: 66% of 450 patients with stab wounds could eventually walk without or with only minimal help in one series and over half of 217 patients returned to their former occupation, usually within 6 months of the injury, in another. [4,84] Brown-Sequard types of lesion (i.e., hemisections) also recover: for instance, two patients with cervical hemisection recovered walking at 10 and 2 years [35] and another recovered almost completely at 3 years.…”