[Case report of acute central cervical cord injury with C7 laminar fracture and extradural hematoma (author's transl)].
A 57-year-old epileptic male with an acute central cervical cord injury was reported, who fell down from 2.5 meter height to a dry river bed presumably during a convulsive seizure. Upon physical examination at the time of admission, 4 hours post trauma, there were severe neck pain with limited neck motion, sensory level at C4 bilaterally, no motion at all in the upper extremities, and minimal motion in the lower extremities as well as apparent urinary retention. Plain cervical spine series showed moderate posterior osteophytes at C4--C5 and C5--C6, although the film of lateral view did not visualize a part of C7 well. After 4 days' clinical observation, a myelography was done at lateral cervical approach between C1 and C2, which showed a complete block at C3. Urgent laminectomy C3 through C7 showed a fracture of the C7 spinous process extending to the bilateral lamina and an extradural hematoma from C3 to C7 with thickness of 3 to 5 mm. Neither pial incision nor dorsal myelotomy was performed because of no remarkable swelling of the cord. Post-operative course was uneventful, the patient recovering first the motion in the lower extremities, urinary retention, and motion in the upper extremities. At 10 months' follow-up after the operation, he could take care of himself in dressing, eating and toileting, although he had had residual motor disturbance in his hands and fingers especially in fine finger movements. It was keenly felt important to visualize C7-T1 in roentgenograms of lateral cervical view in cases of acute cervical injury, for which swimmer view and/or tomogram might be necessary. Queckenstedt's test was criticized as a dangerous maneuver in such case but C1--C2 myelography is considered safer and more informative. Literature on the acute central cervical cord injury were reviewed.
D000208:Acute Disease; D002574:Cervical Vertebrae / Q000293:injuries*; D050723:Fractures, Bone / Q000150:complications* / Q000601:surgery; D006407:Hematoma, Epidural, Cranial / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000150:complications* / Q000601:surgery