ICT Based Cervico-Dorsal Dislocation Fixation
Cervico-Dorsal Dislocation Injuries are around 3 to 9% of cervical injuries.
But these injuries may pose difficult problem of missing pathology on X-rays especially in unconscious patient.
The possibility of this junctional area injury should be borne in mind in head and chest injury patient specially when not fully conscious. Adequate visualization of the
cervicothoracic junction together with full protective spinal measures employed in all cases until satisfactory studies are completed and formally reported.
In equivocal cases, arrangements for alternative imaging methods such as swimmer views, CT and MRI
should be made.
A young female with history of road side accident presented in emergency department having neurology of C7 Quadreplegia. X-rays of cervical spine were incomplete and cervico-dorsal junction was not visible So CT Cervical spine was performed showing Cervico-Dorsal Dislocation.
Cervical traction was applied but dislocation failed to get reduced.
ORIF was planned and executed.
As earlier mentioned that this area is poorly visualized on x-ray and Fluoroscope. Fluoroscopy was of little help in this case
Pre surgery CT Scan in theatre and Intraoperative CT helped in accurately placing screws.
Superior Facets were drilled but Flouroscopy failed to tell us whether reduction was possible or not.
Intraoperative CT showed not only reduction is done and lateral mass screw of C6 were properly placed.
BUT right sided transpedcicular screw of D1 was medially directed violating the spinal canal.
That was picked intraoperatively and redirected in same setting.
Intraoperative CT Scan is very helpful in complex spinal surgery as it increases safety of patient and real time information helps surgeon to act immediately for minimizing complication.
