Complete dislocation of the neck following trauma (Grade 4 Spondylolisthesis)
Road traffic accidents can sometimes lead to head and neck injuries. Neck injury can be mild as in whiplash injury, moderate or severe (with broken bones and spinal cord injury). Patients can present with varying degrees of damage to the spinal cord. Most patients present with partial or complete paralysis of the arms or legs or both. This is because the spinal cord carries all the nerves that supply movement and sensation to the rest of the body. If the cord is severely damaged, the paralysis may be permanent. This includes loss of sexual function and loss of the ability to urinate or pass stool normally.
The worst case scenario is the patient with complete dislocation (cervical spondyloptosis) and often complete damage to the spinal cord. Management is difficult and requires operative intervention. The operation is difficult and requires careful thought and efficient post operative care. The days following surgery are crucial and there must be really good attention to details and correction of physiological problems. Recovery is often poor with permanent paralysis. The impact on the life of the patient and family is unimaginable.
Example below: CT scan of the neck of a patient with complete C5/C6 dislocation.
Same case below: X-ray following surgery and anterior plating with bone graft
MRI scan below: Months later showing the area of complete spinal cord transection.
There was no recovery of function below the level of injury
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