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Images in Neurology
June 2013

A Complete C3-C4 Spinal Dislocation

Author Affiliations

Author Affiliations: Department of Orthopedics of First Affiliated Hospital and Orthopedic Institute, Soochow University, Suzhou, Jiangsu, China.

JAMA Neurol. 2013;70(6):802. doi:10.1001/jamaneurol.2013.1948

A 37-year-old man presented to the emergency department with a cervical injury after he was involved in a head-on bicycle collision with a truck and fell on his forehead. Radiography indicated a 100% anterior dislocation at C3 and C4 (Figure 1). He experienced complete paralysis of his left upper and lower extremities, and he experienced incomplete paralysis of his right upper and lower extremities. He had partial incontinence. A computed tomographic scan was not taken, to avoid potentially catastrophic cervical motion. Owing to the severity of the trauma, the patient had a tracheotomy and was treated conservatively with cervical traction for 1 month, followed by placement of a head-neck-thoracic plastic cast for 2 months. A significant amount of his sensory and motor functions were recovered, and no surgery was performed during his recovery period. At his latest hospital visit, 19 years after the accident, the patient was normal physically and neurologically. He had normal alignment of the cervical spine with a thinner C3-C4 intervertebral space (Figure 2) from residues of intervertebral disk and bony fusion.

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