PMC3789362_01
Conventional X-rays on admission showing fracture dislocation C4/5 (left); preoperative CT scan showing unilateral facet dislocation (middle); MRI after closed reduction (upper right); CT scan after anterior decompression and stabilization (lower right).
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PMC3789362_01_CRIM.ORTHOPEDICS2013-272865.001.jpg
fig1
A). Along with the ATLS guidelines, a lateral conventional X-ray of the cervical spine was conducted, which showed fracture dislocation C4/5 (cf.  Figure 1, left). According to the NASCIS-2 protocol, high-dose methylprednisolone was administered. Immediate trauma CT scan showed fracture dislocation C4/5 with partially locked facet dislocation C4/5 on the right side and raised suspicion for dissection of the right vertebral artery (cf.  Figure 1, middle). Emergency reduction was performed at approximately 120 minutes after trauma, and MRI scans were performed, which showed a marked reduction and confirmed dissection of both right vertebral and internal carotid arteries (cf.  Figure 1, upper right). Subsequently, at approximately 7 hours after trauma, a standard anterior decompression, discectomy, and fusion were carried out (cf.  Figure 1, lower right).