Abstract
Fracture or dislocation of the cervical spine often causes a severe degree of palsy. Fortunately, there exist some cases with little or no palsy of the spinal cord, in spite of fracture or dislocation of the spine. In such cases, extremely atraumatic manipulation should be taken in reducing the dislocation, so as not to aggravate the palsy.
We have experienced five such cases of fracture or dislocation of the cervical spine with little or no palsy. The purpose of this study is to describe the method and results of treatment.
Surgery (combined with both posterior and anterior approaches) was done in all cases. In four cases, posterior reduction was performed under local anesthesia, and then anterior interbody fusion with plate fixation under general anesthsia. In the fifth case, in which reduction wes obtained before operation, posterior wiring and anterior fusion without plating were performed under general anesthsia. The results of all five cases were satisfactory, with no aggravation of palsy.
Recent advances in spinal cord monitoring using electrophysiological means are revolutionary, although not yet perfect. Local anesthesia is still useful in manipulating the unstable spine to prevent further aggravation of spinal cord injury. Pain during surgery can be overcome by a detailed explanation of the situation to the patient.
