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Traumatic cervical cord transection without facet dislocations--a proposal of combined hyperflexion-hyperextension mechanism: a case report.

Cha YH, Cho TH, Suh JK - J. Korean Med. Sci. (2010)

Bottom Line: Previous reports have described central cord syndromes occurring in hyperextension injuries, but in adults, acute spinal cord transections have only developed after fracture-dislocations of the spine.A case involving a post-traumatic spinal cord transection without any evidence of radiologic facet dislocations is reported.Also, we propose a combined hyperflexion-hyperextension mechanism to explain this type of injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
A patient is presented with a cervical spinal cord transection which occurred after a motor vehicle accident in which the air bag deployed and the seat belt was not in use. The patient had complete quadriplegia below the C5 level and his imaging study showed cervical cord transection at the level of the C5/6 disc space with C5, C6 vertebral bodies and laminar fractures. He underwent a C5 laminectomy and a C4-7 posterior fusion with lateral mass screw fixation. Previous reports have described central cord syndromes occurring in hyperextension injuries, but in adults, acute spinal cord transections have only developed after fracture-dislocations of the spine. A case involving a post-traumatic spinal cord transection without any evidence of radiologic facet dislocations is reported. Also, we propose a combined hyperflexion-hyperextension mechanism to explain this type of injury.

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Related in: MedlinePlus

Summarization of the hypothesized mechanism of the injury. (A) During the initial short moment of the collision, the airbag is just in contact with the torso, but not with the face of the patient. As a result, compressive flexion force interacts at the cervical spine, resulting in C5, C6 vertebral body fractures. (B) In the late stage, the patient override the airbag, which causes him to hit his head on the roof and windshield of the vehicle, resulting in acute cervical hyperextension. The spinal cord transection occurs by posterior displacement of the C5 vertebral body against the cord in this powerful distractive extension injury.
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Figure 5: Summarization of the hypothesized mechanism of the injury. (A) During the initial short moment of the collision, the airbag is just in contact with the torso, but not with the face of the patient. As a result, compressive flexion force interacts at the cervical spine, resulting in C5, C6 vertebral body fractures. (B) In the late stage, the patient override the airbag, which causes him to hit his head on the roof and windshield of the vehicle, resulting in acute cervical hyperextension. The spinal cord transection occurs by posterior displacement of the C5 vertebral body against the cord in this powerful distractive extension injury.

Mentions: The above mechanism of injury could explain the cord transection and injuries involving the posterior vertebral column. However, C5, C6 vertebral body fractures are unresolved. According to Allen's classification of subaxial cervical fractures and dislocations (15), our patent's injury was a distractive extension stage 2 lesion. In this type of injury, however, there was no co-existing vertical fracture centrum. Therefore, we propose the hypothesis that during the initial short moment of the collision, the airbag was just in contact with the torso, but not with the face of the patient. As a result, compressive flexion force interacted at the cervical spine, resulting in C5, C6 vertebral body fractures. This hypothesized mechanism is summarized in Fig. 5.


Traumatic cervical cord transection without facet dislocations--a proposal of combined hyperflexion-hyperextension mechanism: a case report.

Cha YH, Cho TH, Suh JK - J. Korean Med. Sci. (2010)

Summarization of the hypothesized mechanism of the injury. (A) During the initial short moment of the collision, the airbag is just in contact with the torso, but not with the face of the patient. As a result, compressive flexion force interacts at the cervical spine, resulting in C5, C6 vertebral body fractures. (B) In the late stage, the patient override the airbag, which causes him to hit his head on the roof and windshield of the vehicle, resulting in acute cervical hyperextension. The spinal cord transection occurs by posterior displacement of the C5 vertebral body against the cord in this powerful distractive extension injury.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2908802&req=5

Figure 5: Summarization of the hypothesized mechanism of the injury. (A) During the initial short moment of the collision, the airbag is just in contact with the torso, but not with the face of the patient. As a result, compressive flexion force interacts at the cervical spine, resulting in C5, C6 vertebral body fractures. (B) In the late stage, the patient override the airbag, which causes him to hit his head on the roof and windshield of the vehicle, resulting in acute cervical hyperextension. The spinal cord transection occurs by posterior displacement of the C5 vertebral body against the cord in this powerful distractive extension injury.
Mentions: The above mechanism of injury could explain the cord transection and injuries involving the posterior vertebral column. However, C5, C6 vertebral body fractures are unresolved. According to Allen's classification of subaxial cervical fractures and dislocations (15), our patent's injury was a distractive extension stage 2 lesion. In this type of injury, however, there was no co-existing vertical fracture centrum. Therefore, we propose the hypothesis that during the initial short moment of the collision, the airbag was just in contact with the torso, but not with the face of the patient. As a result, compressive flexion force interacted at the cervical spine, resulting in C5, C6 vertebral body fractures. This hypothesized mechanism is summarized in Fig. 5.

Bottom Line: Previous reports have described central cord syndromes occurring in hyperextension injuries, but in adults, acute spinal cord transections have only developed after fracture-dislocations of the spine.A case involving a post-traumatic spinal cord transection without any evidence of radiologic facet dislocations is reported.Also, we propose a combined hyperflexion-hyperextension mechanism to explain this type of injury.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Korea University College of Medicine, Seoul, Korea.

ABSTRACT
A patient is presented with a cervical spinal cord transection which occurred after a motor vehicle accident in which the air bag deployed and the seat belt was not in use. The patient had complete quadriplegia below the C5 level and his imaging study showed cervical cord transection at the level of the C5/6 disc space with C5, C6 vertebral bodies and laminar fractures. He underwent a C5 laminectomy and a C4-7 posterior fusion with lateral mass screw fixation. Previous reports have described central cord syndromes occurring in hyperextension injuries, but in adults, acute spinal cord transections have only developed after fracture-dislocations of the spine. A case involving a post-traumatic spinal cord transection without any evidence of radiologic facet dislocations is reported. Also, we propose a combined hyperflexion-hyperextension mechanism to explain this type of injury.

Show MeSH
Related in: MedlinePlus