Cervical Spondyloptosis: Patients with completely broken necks

CERVICAL SPONDYLOPTOSIS: CASE REPORTS AND REVIEW OF THE LITERATURE

Biodun Ogungbo, Consultant Neurosurgeon, Cedarcrest Hospital, Abuja, Nigeria

OBJECTIVES:

To present nine cases of patients with traumatic cervical spondyloptosis managed in Abuja. The management protocol and outcome may prove instructive in managing patients with this severity of injury to the cervical spinal cord.

MATERIALS AND METHOD

Nine patients with cervical spondyloptosis presented to the unit. These are consecutive patients in a cohort of patients with spinal trauma managed by a single neurosurgeon from August 2009 to date. We collected data on the demographics, presentation, radiology, management and recent outcomes on these patients. Pre-operative and post-operative Frankel grades within 48 h were recorded. Final outcome, evaluated using the Bathel disability index, was scored by 30 September 2011.

RESULTS

Nine patients had severe vertebral dislocations (grade 4), bifacetal dislocations and fractures of the posterior elements. All underwent anterior cervical discectomy and fusion as a first step. Two underwent additional posterior fixation with soft wires and bone grafts. We were unable to achieve satisfactory reduction in two patients. Both were plated insitu anteriorly. One was stable and the other re dislocated within two weeks. He subsequently died. Four more have died as at last follow up review. Remaining patients are quadriplegic and only one has been satisfactorily rehabilitated, and socially functional.

CONCLUSIONS

Spondyloptosis of the cervical spine is not a rare injury in Nigeria. Traumatic cervical spondyloptosis was associated with complete and irreversible spinal cord injury. Post operative care is intensive and fraught with dangers such as pyrexia, hypotension and hypoxia. The risks of death are high within 2 months of the operation. These patients are extremely difficult to manage especially in resource poor communities.

KEY WORDS: Anterior cervical discectomy, cervical spine traumatic instability, Cervical Spondyloptosis, Nigeria, Outcome, Surgical fixation, Trauma