High-Grade Traumatic Cervical Subluxation Injuries: Treatment strategies and Outcomes

Keywords: cervical spine, outcome, trauma, spinal fusion, spinal instrumentation

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     Traumatic high-grade (<50%) cervical subluxations are uncommon spinal injuries, often associated with severe neurologic compromise. Particularly, traumatic cervical spondyloptosis (<100% subluxation) is rare, with little reported in the literature regarding treatment and outcome.
     To the best of our knowledge, we present the first reported case series describing management of these complex spinal injuries.
     Eleven patients with high-grade subluxation were identified, 7 who had <=100% subluxation. Ages ranged 19 to 76 years.
     A study at three level 1 trauma centers was performed of patients with traumatic cervical subluxation <50%. Charts were assessed for clinical presentation, treatment modalities, admission and post- treatment neurologic status, and complications.
     High- energy closed spinal injury was the mechanism in all but one patient. Admission ASIA grade varied (A=4; B=1; C=4; D=1, E=1). Ten patients underwent halo traction with five(50%) failing closed reduction. High-dose methylprednisolone was administered in 4 patients. All patients underwent surgical stabilization +/- open reduction: anterior only(n=3), posterior only(n=3), combined anterior-posterior(n=5). Four patients(36.4%) had good post- treatment neurologic outcome(ASIA D, E), 2 of whom improved one ASIA grade. One additional patient remained ASIA B, however, improved in neurologic level of injury post-treatment. Complications included neurologic worsening(n=1), traction pin- site scalp laceration(n=2), hardware failure(n=1), vertebral artery injury(n=1), infection(n=1), DVT(n=1), death(n=1).
     This is a retrospective study.
     High grade traumatic cervical subluxations are complex, unstable injuries. Remarkably, 45.5% demonstrated good neurologic outcomes as defined as improvement in ASIA grade, neurologic level of injury, or preservation of good ASIA grade.
     Pre-operative traction did not significantly improve neurologic outcome and was associated with high failure rate of reduction. Likely due to severity of these injuries, there was a high incidence of related complications. However, given the observed potential for neurologic improvement, we recommend aggressive surgical reduction and stabilization for these complex spinal injuries.


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