It is a dislocation of the bones in the cervical spine due to trauma. Dislocation can only happen if there is structural damage to both the front and back of the bony spine.
The spinal cord can also suffer injury as a result of traumatic cervical dislocations.
A traumatic cervical dislocation would lead to severe neck pain and inability to hold the neck erect. Thereby, the patient’s neck should be immediately immobilized in a collar to prevent further movement of an unstable spine and thereby prevent further spinal cord injury.
Further symptoms such as weakness/paralysis, numbness, urinary retention (bowel/bladder involvement) would depend on the extent of spinal cord injury. High spinal cord injury can also lead to decrease in respiratory drive requiring ventilation and fall in blood pressure.
MRI would diagnose the extent of dislocation and the extent of spinal cord injury. CT scan/xray would delineate the damage to the bony spine better than MRI.
Surgery. Surgery may be needed from the front or the back of the neck or both from the front and the back depending upon the biomechanical nature of the dislocation and spinal cord compression.
Most surgeons use traction on the cervical spine pre-operatively and intra-operativelyto reduce the dislocation and bring the alignment of the bony spine to normal. Traction is applied through tongs fixed to the skull by sharp metal pinswith the small associated risk of skull perforation and brain damage. I find this contraption rather grotesque and dangerous because sometimes traction is applied on a compressed and damaged spinal cord.
I therefore use a Biomechanical approach whereby as a first step, all compression on the spinal cord is removedsurgically to increase the safety of the procedure and thereafter the screws and rods which will be finally inserted for fixation of the spine in normal alignment are themselves used to reduce the dislocation without the use of grotesque pins in the skull.
Surgery from the front of the neck is done through a small incision via which the surgeon reaches the front of the bony spine and thereafter under microscopic vision, removes all the bone and the discs compressing the spinal cord. After taking the pressure off the spinal cord, the surgeon fixes the bony spine in its normal position by Titanium/PEEK cages which are fixed by screws and plates to the normal vertebral bodies above and below the gap created in the bony spine.
Surgery from the back of the neck is done through an incision in the midline. Pressure on the spinal cord is relieved and the bony spine is fixed in its normal position by screws and rods placed laterally on the sides of the spine.
The patient has to wear a collar for some time following the surgery to avoid aggressive neck movements.
An aggressive exercise/physiotherapy regimen is crucial to maximizing recovery post-operatively and needs to start from post-operative day 1.
The first purpose of surgery is to stabilize and fix the unstable bony spine in its normal position thereby preventing further spinal cord damage from an unstable spine. Patients with no neurological symptoms are near normal immediately post-operatively.
Recovery in patients who already have symptoms of spinal cord injury depends on extent of symptoms, extent of spinal cord damage on pre-operative MRI and precision of surgery. Recovery will happen slowly over many months and is maximized by an aggressive exercise/physiotherapy regimen. However, the extent and time-period of recovery is unpredictable. But it must be mentioned that patients with some amount of preserved power in the hands and legs prior to surgery exhibit miraculous improvement over a few months.
Severe spinal cord injury resulting in near paralysis and bowel/bladder involvement may not recover completely.
There are some medications for residual symptoms such as spasticity/heaviness of the legs, paraesthesias or abnormal sensations, burning sensations, nerve pain radiating along the arms or legs.
