PMC5591568_01
Initial diagnostic workup of the cervical spine injury with CT (panels a-f) and MRI (panels G,H). The sagittal views in panels a-d demonstrate the fracture dislocation with the left sided perched facet (panel c, and arrow in panel b) and the right sided facet fracture-dislocation (panel d). The posterior traumatic laminotomy is shown in axial CT images of C6 (panel e) and C7 (panel f). Panels g and h are sagittal STIR-weighed MRI images of the cervical spine, demonstrating the extruded C7/T1 disc within the spinal canal (panel h is a magnification of panel g
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Fig1
T1, with rotational instability (AO/OTA classification 51-C2.1). The injury pattern included a C7/T1 fracture-dislocation (Fig. 1a) with a left-side locked/perched facet at C6/C7 (Fig. 1b,c), a right side facet fracture-dislocation at C7/T1 (Fig. 1d), and a "saving" traumatic laminotomy at C6 and C7 on right side (Fig. 1e,f). The MRI demonstrated a complete disruption of the annulus fibrosus of the C7/T1 intervertebral disc, a disruption of the anterior longitudinal ligament (ALL) and posterior longitudinal ligament (PLL) at the same level, and a complete extrusion of the C7/T1 disc into the spinal canal, positioned behind the C7 vertebral body (Fig. 1g,h).
Lateral radiograph of the cervical spine after posterior C4-T1 fusion and anterior C7 corpectomy and fusion
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Fig2
The previous anterior cervical wound was re-opened. The exposed dura was visualized through the preceding C7 corpectomy, and a 2-level anterior fusion from C6-T1 was performed with a PEEK cage filled with autograft bone from the resected C7 vertebra, and placement of a 2-level anterior locking plate (Fig. 2). The anterior wound was then closed, the
The patient and his wife giving a "thumbs up" in the surgical intensive care unit on postoperative day 1 after spinal fusion and Halo removal
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Fig3
He tolerated the procedure well and was extubated in the operating room. His neurological exam was normal and the hypoesthesia in the right C8 dermatoma resolved postoperatively (Fig. 3).
The patient depicted on his first street bicycle race at 10 months post injury, with an accompanying letter of gratitude
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Fig4
He was back riding his bicycle at 7 months, and by 10 months after surgery he had returned to competitive street bicycle racing in the 100 mile "Elephant Rock Century Ride" in Castle Rock, Colorado (Fig. 4).