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Pathological C1/2 Fracture Dislocation

History

61 year old female. Fell at home. Relatively benign injury. Unable to straighten neck, pain upper cervical spine. Unable to swallow..

Examination

Normal upper and lower limb neurology. Abnormal cervical spine posture. Chin subtracted, Loss of cervical lordosis. Unable to swallow. Fungating perineal tumour.

Imaging

XRAYS

  

CT SCANS

Shows a comminuted pathological fracture of the odontoid peg associated with C1/2 subluxation. Marked widening of the interspace between posterior C1 and C2 processes. There is also erosion of the C6 vertebral body.

MRI SCANS

The spinal cord has escaped significant injury despite the marked subluxation.

Diagnosis

C1/2 subluxation. Tumour erosion of C2 Odontoid peg, body and C1 anterior arch. Metastatic lesion in C6 vertebral body.

Biopsy of perianal lesion confirmed squamous cell carcinoma of the anus.

Treatment

Palliative surgical treatment.

Realigment of spine and Posterior Occipito-Cervical stablisation + fusion (C0 - C7). Radiotherapy to C1/2 and C6..

Surgical Details

Patient positioned prone. C1/2 carefully reduced with gentle cervical spine traction and dynamic fluoroscopy, reduced to anatomical alignment. Midline Posterior approach. Occiput decorticated. Synthes Cervifix system used to stabilise spine. Spinous process bone grafts + artificial bone substance. Lateral mass screws used at all cervical spine levels. Crosslink used

  

Post Op Follow Up

Patient discharged from hospital functioning well.

Neurological examination reveals normal neurology.

 

Disclaimer

Please note that each case is considered individually and not all patients have the same result from surgical intervention. We do not guarantee this type of recovery in every patient and in fact some patients may not improve from surgery. You should discuss your problem with your own doctor and consider carefully all the treatment options before considering surgery. You should be aware of all serious risks of surgery before undergoing intervention.

 





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Copyright Orthopaedics.Com Ltd Dr M Akmal MD FRCS(Orth)