Due to the need to immediately restore appropriate spinal anatomy and decompress the cervical neural elements, arrangements were made with trauma surgery at a tertiary care center to transfer the patient, stabilize his liver laceration with interventional radiology embolization and blood transfusions, and prepare him for spinal instrumentation. He was then taken to the operating room emergently for an anterior cervical diskectomy and fusion at the C6-7 level with intraoperative reduction under neurophysiologic monitoring. The case proceeded in an uncomplicated fashion with manual surgical reduction of his fracture under fluoroscopy and placement of a large titanium graft with anterior cervical plating.
Postoperatively he did extremely well with a stable neurological examination. He ambulated within 24 hours of surgery and was discharged uneventfully on his sixth postoperative day with no functional motor deficits.
This case demonstrates the critical importance of urgent neurosurgical consultation even with a clinically “normal” patient, as well as the need for multidisciplinary evaluation at an appropriately staffed trauma center with round-the-clock coverage of tertiary surgical subspecialties. Aggressive workup and management is especially warranted in neurologically stable patients with unstable spinal column fractures, as they can deteriorate rapidly with undiagnosed injuries and early intervention is key to an excellent outcome.
This 66-year-old male was involved in a high-impact vehicle collision. On initial evaluation he was complaining of severe abdominal and localized neck pain, and was subsequently brought to a local hospital. Initial trauma workup was significant for a severe (grade IV) liver laceration and comminuted cervical spine fractures. When he was initially evaluated he was found to have no clinical signs of spinal cord injury but radiologic CT evidence of neck fracture and bilateral “jumped and locked” facet joints at the C6-7 level, a highly unstable cervical fracture with significant malalignment of the spinal column.