Posterior fusion for an unstable axial fracture dislocation
A 34-year-old woman presented with acute onset of neck pain after her car was rear-ended in a low-speed motor vehicle accident. Examination revealed a patient with a body mass index (BMI) of 50, normal neurological examination, and limited range of motion in the neck. A primary cervical spine computed tomographic (CT) scan showed a displaced fracture involving the anteroinferior aspect of the body of C2, widening of the right C2-C3 facet joint, and a prevertebral hematoma []. These findings prompted magnetic resonance imaging (MRI), which showed disruptions of the anterior and posterior longitudinal ligaments and the right and central posterior ligamentous complex []. A small, ventral, epidural hematoma was noted at C2. These findings, in combination with a developmentally narrow spinal canal, created moderate spinal canal stenosis.\nThe extensive ligamentous injury prompted surgical stabilization. Surgery involved posterior screw-based instrumentation from C2-C4 using the Mountaineer® OCT Spinal System (DePuy Spine, Inc., Raynham, MA) augmented by a corticocancellous autograft to the decorticated articular surfaces of C2-C3 and C3-C4. Isthmic screws were placed at C2. Additional C2 trans-spinous laminar screws were placed bilaterally through the spinous process into the lamina at an almost perpendicular angle to the initial screw, firmly securing the top end of the construct. Lateral mass screws were placed bilaterally at C3 and C4. At a 6-month follow up, a radiograph of the cervical spine showed a solid fusion []. The patient's neurologic status remained stable.