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04-OCTOBER-2008  ISSA SALMAN HADDAD  28 YEARS  UNSTABLE FRACTURE C6 AND C7 WITH PARAPLEGIA BELOW C6 AFTER RTA 02-OCTOBER-2008.

Anamnesis:

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The patient came to the emergency of Al-Shmaisani hospital 03-October-2008 after suffering RTA 02-October-2008 with clinical picture of paraplegia at C6 level.

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MRI of whole spine performed today showing unstable fracture of C6 and wedging of C7 with contusion and malacia of the spinal cord at theses levels.

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On examination: the patient had complete paraplegia below D1 and severe paresis below C5 and paraaneasthesia below D4 left side and D2 right side.

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The patient was put under observation for vital signs and massive dose of decadron was started.

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The next day before surgery reevaluation confirmed improvement of the power of upper limbs with the biceps 4/5 and grip of the hands 3/5 and extension of the hands 3/5 and triceps 2/5 both sides.

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In supine position with halo traction 5 Kg applied to the head, anterior approach to C5 down to D1 was achieved. Considering that the disci were in acceptable position, it was decided not to violate them. Check image-intensifier showed good reduction of the fractured C6 and C7.

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Using Hybrid miniplate 48 mm length and 6 screws, fixation of C5, C7 and D1 was performed. The C6 was not included in screw insertion to avoid bone dislodgment during screw insertion. Serial check X-rays confirmed good alignment and good positioning of the construct.

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Routine closure of the wound. The power of both upper limbs improved slightly and the patient could feel the toes with crude sensation better at the left side.

Comments

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The patient has unstable fracture of C6 with wedging of C7.  Reduction and fixation is mandatory to prevent further trauma to the already traumatized spinal cord.

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The improvement of the neurological deficit is drug induced and not related with surgery.

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