Multiple unstable cervical fractures with cord compromise treated nonoperatively: a case report.

Abstract

The case of a 17-year-old boy who sustained an unusual pattern of multiple unstable cervical spine fractures with a spinal cord injury is presented. To review the management and treatment of multiple unstable cervical spine fractures. SUMMARY OF BACKGROUND DATA.: Combined unstable cervical spine injuries are uncommon. Treatment of multiple-level cervical spine fractures remains controversial. The case of a 17-year-old boy who sustained a ring fracture of the atlas, an atypical traumatic spondylolisthesis of the axis, bilateral pedicle fractures of C3 with significant anterior subluxation of C3 on C4, a C6 burst fracture, compression fractures of C7 and T1, and significant cord compression as the result of a motor vehicle accident is presented. The patient was successfully treated with an initial closed reduction using cervical traction for 1 week followed by placement of a cervical halo vest. The fractures healed successfully, and the patient regained near-normal neurologic function. Despite advances in the surgical treatment of cervical fractures and dislocations, nonoperative treatment with halo immobilization remains a viable option for selected complex injury patterns.