Neurologic compromise after an isolated laminar fracture of the cervical spine.

Abstract

Report of a rare fracture of the cervical spine. To illustrate the importance of the cervical spinolaminar line in the diagnosis of this unusual injury and to comment on appropriate investigations, management, and outcome. Laminar fractures of the cervical spine are uncommon and are often missed. They usually occur after a hyperextension injury. It is unusual for these injuries to cause neurologic compromise. The injury reported here differs in that it was a result of direct trauma to the posterior aspect of the neck, and there was a significant neurologic deficit. The clinical findings, roentgenographic appearance, treatment, complications, and follow-up assessment are presented and discussed. Initial neurologic examination revealed a right hemiparesis. Radiographs showed disruption of the spinolaminar line at C5 and a computed tomography scan revealed a fracture of the lamina of C5 with spinal canal encroachment. Management included high-dose corticosteroid administration and a posterior spinal decompression. The patient's initial postoperative course was complicated by acute pulmonary edema, which responded well to intravenous Furosemide and ventilation. Follow-up assessment showed significant neurologic improvement. The satisfactory outcome in the case of this rare injury was the result of a prompt, accurate diagnosis and appropriate management.