Fractures and dislocations of the cervicothoracic junction.

Department of Orthopaedics, Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK.
Journal of Spinal Disorders & Techniques (Impact Factor: 1.89). 01/2006; 18(6):499-505. DOI: 10.1097/01.bsd.0000156831.76055.f0
Source: PubMed

ABSTRACT Presented is a retrospective review of case notes and all available imaging studies in seven patients with acute fractures-dislocations of the cervicothoracic junction. Imaging studies included radiographs (five cases), computed tomography (six cases), and magnetic resonance imaging (seven cases). The study group consisted of five men and two women with mean age at presentation of 43.6 years (range 25-69 years). Four patients had been in road traffic accidents, whereas three patients had had falls. Three patients sustained complete neurologic deficits with no recovery, whereas the remaining four had no abnormal neurology or mild deficit at presentation and were normal at final follow-up. The injury was missed initially in three cases. The commonest injury pattern was traumatic spondylolisthesis of C7 on T1 with multilevel neural arch fractures, resulting in increased anteroposterior canal dimensions (four cases). Bilateral pars fractures of C7 and pure facet dislocation were seen in one case each. Neurologic deficit was related to the degree of anterior displacement of C7 on T1. Fracture-dislocation at the cervicothoracic junction is a rare injury with a variation of injury patterns and neurologic outcome.

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    ABSTRACT: Background context Several authors have reported cervical dislocations and fracture-dislocations above, below or through the fused cervical segment after cervical fusion. No previous reports have described fracture/dislocations at the cervicothoracic junction (CTJ) after multilevel anterior cervical spine fusion. Purpose To report CTJ fracture/subluxation after multilevel anterior cervical spine fusion surgery, a technique for surgical management and strategies to prevent this avoidable complication. Study design A case report and review of the literature. Methods A 61-year-old women underwent anterior cervical decompression and fusion (ACDF) from C3 to C7. The patient did well postoperatively until she suffered a CTJ fracture/subluxation 4 months later sustained during a fall. Results The patient underwent posterior and anterior fusion surgery C7–T2. Radiographs 2 years after her reconstruction surgery showed solid fusion from C3 to T2. Conclusions The CTJ area is susceptible to injury because it represents the transition between mobile and relatively immobile portions of the spine, especially when a long lever arm is created by a low cervical fusion. It is difficult to image with plain radiographs, and therefore, injury may be easily overlooked. If overlooked, severe neurological injury can result. Anterior and posterior fusion is often necessary to appropriately stabilize the CTJ after fracture/dislocation.
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