Delayed traumatic cervical cord transection

Cervical spinal cord injuries associated with resuscitation from fatal circulatory collapse

Introduction

Fatal cervical spinal cord injury (SCI) associated with collapse of the circulatory and/or respiratory system usually consists of high cervical SCI caused by high-energy trauma. As the elderly population grows, however, the etiology of fatal SCI may be changing. The aim of the present study was to understand the current clinical features of fatal SCI.

Methods

Retrospective analysis was performed on 73 consecutive patients with acute cervical SCI between 2007 and 2013. Fourteen (19%) of them presented in a state of coma due to severe circulatory collapse after cardiac arrest (CA, n = 11) or respiratory arrest (RA, n = 3), and were resuscitated at the scene or hospital. The clinical features and radiological findings of these 14 patients were compared with those of the other 59.

Results

Eleven of the 14 fatal SCI patients were injured by minor traumas. Computed tomography revealed C1-2 fractures or dislocations in 11 patients and subaxial injuries in three patients. Eleven patients showed some kind of ossification of the spinal column ligaments. In a univariate analysis, the predictive factors associated with fatal circulatory collapse were age (P = 0.02), estimated C1/2 injury (P < 0.0001), and complete tetraplegia (P < 0.0001). In a multiple regression model for fatality, the odds ratios (OR) for C1/2 injury and ASIA impairment score (AIS) A were 20.58 (P = 0.006) and 151.97 (P = 0.002).

Conclusions

A state of unconsciousness with fatal circulatory collapse was significantly associated with C1/2 injury and AIS A. Moreover, our data show that fatal SCI can occur due to minor trauma in elderly people.

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

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.