Multiple unstable cervical fractures with cord compromise treated nonoperatively - A case report

Study Design. 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. Objective. 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. Methods. 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. Results. 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. Conclusions. 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.