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Abstract: This 42-year-old Mr. Li unfortunately suffered a cervical dislocation, numbness and weakness of the extremities, and was nearly paralyzed after suffering a traumatic injury. Fortunately, the patient was safely and quickly transferred to our hospital after the injury. After surgical treatment and 4 months of standardized rehabilitation during hospitalization, Mr. Li was not only able to live a normal life, but also returned to work.
Basic information】Male, 42 years old
Disease Type】Cervical dislocation
Hospital】Shanghai Long March Hospital
Consultation Time】June 2017
Treatment plan】Surgical treatment (anterior and posterior cervical decompression repositioning implant fusion internal fixation) + physical therapy (cranial traction, hyperbaric oxygen, limb functional exercise)
Treatment period】7 days of inpatient treatment, 4 months of rehabilitation, regular follow-up
Treatment effect】Reset of cervical spine dislocation, normalization of sensory movement of extremities
I. Initial consultation
The patient complained that he fell down 8 hours ago on a battery-operated bicycle and landed on his head and neck, but fortunately he was wearing a helmet. After X-ray and CT examination, it was found that the C5 vertebrae were dislocated forward and the cervical spinal canal was discontinuous. After simple treatment at the local hospital, the limbs could gradually move, but still felt weak, especially the hands were not flexible. For further consultation and treatment, the patient was transferred to our hospital for consultation. The emergency diagnosis was: cervical subluxation with incomplete paralysis.
II. Treatment process
After the patient was admitted to the hospital, relevant examinations were quickly conducted, and it was found that in addition to the cervical subluxation, the spinal cord was stuck due to the discontinuity of the spinal canal, which was the main reason for the patient’s sensory-motor impairment of the limbs. The patient was also suffering from severe pain due to the instability of the subluxation due to the cervical subluxation. If the degree of subluxation further increased, the spinal cord entrapment would also increase, and the patient was at high risk of complete paralysis or cardiac and respiratory arrest, and his condition was quite critical. Therefore, we first performed cranial traction on the patient to temporarily stabilize the cervical dislocation on the one hand, and to achieve a certain degree of repositioning, restore spinal canal continuity, and reduce spinal cord entrapment on the other. After 3 days of traction, the patient’s cervical subluxation was somewhat restored, and the symptoms of numbness and weakness of the extremities were also improved. We then performed anterior-posterior cervical decompression repositioning implant fusion internal fixation on the patient.
III. Treatment effect
After the cervical spine surgery, the patient’s neck pain was completely relieved and the numbness and weakness of the extremities were also somewhat improved. On the 1st postoperative day, the patient could sit up and underwent a review of cervical spine X-ray, which showed a satisfactory reset of the cervical dislocation. After 7 days of hospitalization, the patient’s surgical incision basically healed without any adverse phenomena such as blood leakage or infection, and the patient was permitted to be discharged for recuperation. On our recommendation, the patient underwent 3 courses of hyperbaric oxygen therapy and 4 months of functional limb exercise at the local rehabilitation center. Six months after the operation, the patient was able to walk to our clinic for follow-up, and the function of the limbs had basically recovered, and he could take care of himself completely. Ten months after the operation, the patient returned to work.
IV. Notes
I am very pleased that the patient will return to work after surgery, hyperbaric oxygen and functional exercise of the limbs. Cervical dislocation can be reset immediately after surgery, but it does not mean that the nerve function can return to the preoperative level immediately.
Since the degree of nerve damage is already damaged at the time of injury, even the best surgical techniques can only create conditions for nerve recovery, plus nerve repair is an extremely slow process, so patients need to be advised to keep observing for 1 year, while regular limb exercises, and to go to the hospital for follow-up if pain, swelling and other adverse phenomena occur in the patient’s neck during the recovery process. Since the patient has experienced the double blow of trauma and surgery, the physique tends to be weaker, so it is recommended that the patient can consume high protein food under the premise of normal diet, diversify the daily diet to achieve nutrition, match meat and vegetables, and maintain an optimistic and cheerful state of mind, which can help promote the recovery of the physique.
V. Personal insight
The patient in this article is undoubtedly lucky from the injury to the whole process of recovery. It is good that the patient wore a helmet when he was injured, and the high-energy collision of the head and neck was cushioned to a certain extent, which did not cause complete paralysis despite the cervical dislocation. During the transfer to the hospital, a cervical brace was worn and the cervical spine was protected to a certain extent and the condition was not further aggravated. The whole process from traction to surgery was relatively smooth during the subsequent treatment in our hospital. Finally, the patient complied well and underwent standardized postoperative rehabilitation. All these laid the foundation for his eventual good treatment results.