Search

Total vertebrectomy with spine shortening has been reported for the treatment of difficult cases of traumatic spine dislocation, both in acute and chronic phase. We report an exceptional case of a five-week-old T12-L1 spine dislocation in a 25-year-old female with complete paraplegia as a result of trauma in Ciudad de Leon (Nicaragua). In view of the time since the dislocation, we performed a complete L1 vertebrectomy in order to reduce the dorsolumbar hinge. For osteosynthesis material we had only eight screws and two Steffee plates. We therefore introduced pedicle screws at levels T11, T12, L2 and L3 on the right side and T11, T12, L3 and L4 on the left, and performed manual reduction of the spine. Steffee plates were placed and we added sublaminar wires to reinforce the osteosynthesis. Fifteen months after surgery, there has been no neurological improvement.

We report excellent neurological improvement in a patient with C6/C7 dislocation following a high speed road traffic accident. This case in particular is unusual because the patient was the recipient of an organ transplant during childhood and was therefore on long term immunosuppressant medication at the time of injury. In this report we reflect on the role of steroid use in traumatic spinal cord injury and put our case within the context of current evidence and this unusual clinical scenario.

Charcot spine neuroarthropathy and heterotopic ossification (HO) are known complications of complete spinal cord injury. Heterotopic ossification occurs most frequently around the hip joint. The clinical significance of HO ranges from an incidental finding on radiographs to total ankylosis leading to severely limited range of motion [1,2]. A 54-year-old man with complete T10 spinal cord injury for 34 years was admitted to the authors’ institution with left distal femur fracture. Plain radiograph of the left hip showed severe HO (Fig. 1). Plain radiograph of the spine showed spine dislocation at L3–L4 with osteolysis of the L3 and L4 vertebral bodies (Fig. 2). Computed tomography scan of the spine showed three-column body destruction and bony debris in the paraspinal area characteristic of Charcot spine neuroarthropathy (Fig. 3).

The correction of nasal deformities in cleft patients presents a challenge in the secondary treatment of this malformation. The complexity of the nasal deformity in cleft patients partly depends on the congenital anomaly itself and partly on the surgical procedures which were previously carried out. The nasal deformities in unilateral CLP patients are typical. The nasal floor and the nostril sill are mainly constructed during primary lip repair. While the ala on the cleft side is repositioned, the septum deformity and the anterior spine dislocation are not touched. If large circular incisions are used at the time of primary operation to achieve symmetry, the situation usually deteriorates. One of the main characteristics of a classic cleft lip nose is the deviation of the external nose to the non-cleft side due to the typical septal deformity, where the anterior part of the septum and the caudal edge of the septum are subluxated to the non-cleft side (Fig. 1). Furthermore, there is a typical asymmetry of the nasal tip and the ala (Figs. 5 to 7). The columella is slanted and shortened on the cleft side. The ala cartilage on the cleft side is distorted and displaced. There are two important points in the concept of surgical rehabilitation: First, straightening the deviated nose, which often needs extracorporeal septum correction. This seems to be the prerequisite for correction of the external deviation. Second, rehabilitation includes the correction of the asymmetry of the tip and the nostril. A number of techniques have been suggested for this problem, which indicates that there is no ideal procedure. In our hands the triple-flap repair produced good and reliable results. There was no difference in the results, whether an open approach or an endonasal one was used.

SummaryThe authors describe a case of traumatic lateral spine dislocation at the thoracolumbar junction level, without fracture, in a healthy young adult, complicated by a complete neurological deficit. The main aspects of surgical management are discussed based on a review of the literature. Control of the spinal cord is a mandatory first step, before reduction, independently of neurological deficits considerations. Instrumented stabilization and fusion are achieved thereafter; levels selection for instrumentation and fusion depends on the injury location.

Anterior dislocation of the cervical spine may be detected reliably in the supine frontal projection by evaluating the cervical spinous processes. A widened interspinous distance (ISD) which measures more than one and one-half times the ISD above and more than one and one-half times the ISD below indicates the presence of an anterior cervical dislocation at the level of abnormal widening. Measurements of the interspinous distances from the C3-C4 interval through the C7-T1 interval in 500 patients with normal cervical spines and in 14 patients with documented anterior cervical dislocations revealed neither false positive nor false negative diagnoses by these criteria.

A case is described of bilateral traumatic chylothorax after complete dislocation of the thoracic spine. An explanation is advanced for the delayed, sudden onset of symptoms due to the chylothorax in this and other cases.

Summary 1 Posterior dislocation of the cervical spine is described, and contrasted with the more common type of anterior dislocation. 2 The mechanism of injury is hyperextension, with disruption of the anterior longi- tudinal ligament. 3 In all cases quadriplegia was present. The anatomical basis of this is discussed. 4 The application of these findings to the management of cervical spine injuries is discussed.

The use of traction that can be varied in force and direction of pull and controlled by x-ray is a safe and useful method of treatment of cervical spine injuries. The technic of manipulation is difficult to acquire for the man treating an occasional cervical injury. An analysis of fifty-two consecutive cases of cervical spine injury is presented.

Many therapeutic collars have been designed over a period of years. Most of them are satisfactory. The one described here is simple, comfortable, and effective. The first definite therapeutic collars were made by Hugh Owen Thomas of Liverpool and Schanz of Dresden. Dr. J. O. Wallace of Philadelphia described a collar that he used in the treatment of dislocations of the cervical vertebrae. I found it very useful for other conditions and fashioned mine along Wallace's lines (fig. 1). I always have a supply on hand, firmly rolled, wrapped in cellophane, and sealed with colored cellophane tape. It is a necessary supply in my office. The collar is useful as a first aid measure. It is helpful in taking roentgenograms in cases of acute injuries with or without deformity. In all serious injuries to the head or neck, a collar should be applied before the injured person is moved from