Cervical bone fracture

Anterior Screw Fixation

  • Anterior Screw Fixation

Successful surgery of cervical bone fracture in a patient with anterior screw fixation: A Case Study

Dr. Manish Kumar MBBS, DNB (Neurosurgery)
Surgical Case Reports 2017 © The Park Group of Hospitals. 2017

Abstract

Cervical bone fracture is a medical situation when a bone in the neck region of spine breaks out, whereas, a cervical dislocation is the ligament injury in neck causing an abnormal separation in the adjoining bones of the spine. Although, cervical fractures of the spine are common, yet, the cases of C1 and C2 vertebrae fracture are severe cases requiring more attention and immediate surgery. An electrician, who fell from the electric pole while at work, was brought with C1 fracture in the vertebrae. With difficulty in neck and head movement, the patient also had weak limbs. We divided the treatment in two parts wherein the first part was the Skull Pin Traction and the later the anterior screw fixation surgery was carried out. The patient was discharged after a week of intensive observation and once we saw recovery signs in him with the ability to move his head and neck smoothly.

Background

Cervical bone fracture of is a common yet critical situation as the same requires intensive care and takes at least 6 – 8 weeks to heel. However, the C1 and C2 fractures are not so common. There are more noticeable cases of C4 and C5 injuries. The usual cause of C1 fracture is fall impacting the head or diving. Any incident which lays stress on the head and neck of a person may cause C1 and C2 fractures. These two fractures are highly risk oriented as the location of the affected vertebrae might cause complete paralysis to the individual. There can be a situation where in the fracture has damaged the vertebral arteries and interfere with the neurology system by restricting the blood flow to the brain.

Case Presentation

A 39 year old electrician showed the broken C1 and C2 vertebrae in CT scan when admitted to the Park Hospital, Gurugram. The MRI observed complete damage of C1 and C2 bones of the cervical spine. He was brought in after he had a fall from an electric pole and suffered difficulty in neck and head movement. The emergency and trauma team helped him with the first aid and basic treatment. The treatment was started by the team of neurologists led by Dr. Manish Kumar. The team performed Skull Pin Traction initially to support the head movement and later Anterior Screw Fixation surgery was performed to enable the complete neck movement of the patient. The patient was discharged after a week of observation and the confirmation of him facing no difficulty in the head or spinal movement.

Discussion

According to Dr. Manish, this surgery was very complicated as there was neck bone fracture, which is also known as cervical spine (neck) trauma. The injury is like decapitation. About 25-40% of these fractures are fatal at the time of accident due to cessation of breathing and sudden loss of other vital functions or other associated injuries like Brain injuries. Many patients suffer with severe morbidity because of poor handling during transit or in the hospital sometimes even resulting in prolonged hospital stay and death.

Conclusion

Post surgery, the patient is very well and is also not having any issues with the limbs movement and is also not experiencing any limb weakness. He is eating well and is able to talk properly now as mentioned by the patient himself. He further added to the statement that he was able to walk the next day of the surgery and hopefully will soon have normal range of neck movement.

Declarations

The case study is presented with the consent of the patient and his family members.

Park Hospital, Gurgaon Successfully Completed a Complicated and Unique Neurosurgery

Dr. Manish Kumar a highly experienced neurosurgeon at the super-specialty hospital performed a successful neurosurgery for anterior screw fixation and gave a healthy new life to the patient.Dr.-Manish-with-Patient-light

Gurgaon, Haryana: The multi super-speciality hospital of Park Group, Gurgaon announces to have successfully operated a neck bone fracture through anterior screw fixation surgery.

The patient (an electrician) was admitted to the hospital on 15th June 2017 with a neck bone injury due to his fall off from electric pole. There was severe neck pain and the patient was unable to move his head due to trauma. Although there were no signs of weakness in the limbs and the patient had no signs of breathing issues. Before the major surgery, the patient was given Skull pin traction by the team. Later the Anterior Screw Fixation surgery was done by Dr. Manish Kumar, MBBS, DNB (Neurosurgery) who is a senior neurosurgeon at Park Hospital, Gurgaon.

According to Dr.Manish, this surgery was very complicated as there was neck bone fracture. Also known as cervical spine (neck) trauma. The injury is like decapitation. About 25-40% of dens fractures are fatal at the time of accident due to cessation of breathing and sudden loss of other vital functions or other associated injuries like Brain injuries. Many patients suffer with severe morbidity because of poor handling during transit or in the hospital sometimes even resulting in prolonged hospital stay and death.

“Post surgery, the patient is very well and is also not having any issues with the limbs movement and is also not experiencing any limb weakness. He is eating well and is able to talk properly now,” as stated by Dr. Manish Kumar. He further added to the statement that the patient was able to walk the next day of the surgery and will soon have normal range of neck movement.

Neck bone fractures can be fatal for the patients

  • Cervical Fracture

Cervical Fracture

By Dr. Manish Kumar, Neurosurgeon (MBBS, DNB (Neurosurgery))

Off all the cases of cervical spine (neck) trauma, about one out of five involves the axis (C-2 – the second vertebra of spine in the neck). The commonest type of the axis injury is the fracture at the junction of the odontoid/ dens (the peg like structure from the superior aspect of the axis vertebra in to the first vertebra C – 1 also called as Atlas) and the body of the second vertebra/ axis also called as type II odontoid fracture. The importance of the part of bone called dens can be understood by the fact that this few millimetre-thick bone appears to be the only bony connection between the cervical spine and the head and its fracture is like separation of the head from rest of the body below!

The C1-2 complex allows far more motion than any other single level in the cervical spine. This motion is predominantly rotational, since translational motion at C1- C2 is limited by the strong transverse ligament. This restriction is lost after fracture of the odontoid and may be associated with abnormal movement of the C1-C2 complex in relation to the C2 body. This may result in spinal cord compression producing severe neurological problems. The injury is like decapitation. About 25-40% of dens fractures are fatal at the time of accident due to cessation of breathing and sudden loss of other vital functions or other associated injuries like Brain injuries. Many patients suffer with severe morbidity because of poor handling during transit or in the hospital sometimes even resulting in prolonged hospital stay and death.

In case of type 2 Odontoid fracture, surgical fixation with lag screw passed through the C-2 body up to the tip of the dens is of the first choice if there is no other fracture associated. In case this procedure fails or in case there are other associated injuries, posterior procedure of Occipito cervical stabilisation and fusion is done which results in significant restriction of the neck movements for rest of life.

At Park Hospital, Gurugram on 15th of June, we had a patient with anterior screw fixation of type 2 odontoid fracture who was operated successfully. The patient had come following an injury due to fall from electric pole. The patient is an electric technician, had developed severe neck pain and inability to move the head following the trauma. Luckily he did not develop any weakness of the hands or legs or any difficulty in breathing. Skull pin traction was applied immediately on arrival as the patient was waiting for definitive surgery. Post operatively patient is not having any weakness of hands or legs and is able to talk and eat immediately after the surgery. He could walk on the next day of the surgery. He will have normal range of neck movement.

Park Hospital

Delhi
Gurugram
Faridabad
Panipat
Karnal

+91-7053151515
+91-7503141435
+91-7533033015
+91-7027898989
+91-9643000000