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21-JULY-2010 ABDALLAH ABDEL-KAREEM AL-GHMEZ 56
YEARS RESIDUAL AFTER FRACTURE DISLOCATION C7-D1 WITH RADICULO-MYELOPATHIC
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Saudi citizen came
to the clinic 18-July-2010 complaining of
numbness 10 cm below the nipple with weak
extensors of both hands 4/5 and triceps both
arms 3/5 for 5 months. 6 months ago he was
involved in quarrel and he complain of neck
pain, which resolved after several days.
MRI of the cervical
spine performed 30-June-2010 showing
fracture dislocation C7-D1 with malacia of the
spinal cord and compression of the spinal cord
at this level. MRI repeated 12-July-2010 showing
the same findings.
On examination: the
patient walking with crutches for 2 months. He
has weak extension of both hands 4/5 and triceps
both arms 3/5. There is para-aneasthesia for
pin-brick and touch below D5. All the muscles of
both lower limbs are 4/5. He has micturiton and
The patient was
admitted 19-July-2010 and dexametasone 8 mg TID
Discectomy of C7-D1
was achieved and open reduction was performed
until the alignments became proper. A cage 4.5
mm thickness with novabone was inserted and
Zimmer miniplate was used with 14mm length
screws with 4.5 mm diameter to fuse C7-D1.
Before that the osteophytes in the anterior
upper edge of D1 were removed to provide more
correction of the dislocation. Serial check-ups
was performed at all stages of the operation.
Routine closure of
the wound and smooth postoperative recovery.
The power of all
limbs dramatically improved.
The patient suffered trauma 6
months ago and the neurological deterioration
took place 1 month after the insult. This could
be explained by the presence of fracture in the
lateral masses without dislocation of the C7
over D1. After 1 month the fatigue fracture
developed to dislocation, which caused spinal
cord compression and malacia.
Surgical reduction and fusion
is the only solution, since pseudoarthrosis took
place and no hope for future ossification of the
unstable segment in the near and far
Postoperative Follow Up
The patient after surgery was
surprised and myself with the complete recovery
of his neurological deficits. He was protesting
about the preoperative discussion, that his
recovery will take long time, because there are
severe changes in the spinal cord.
postoperative X-ray showing the reduction
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .