title: Traumatic high-grade cervical dislocation: treatment strategies and outcomes.
abstract: OBJECTIVE
  Traumatic high-grade cervical spinal dislocations are rare injuries, generally associated with severe neurological compromise. In particular, cervical spondyloptosis (>100% subluxation) is rarely reported. The object of our study is to present a case series describing presentation, management, and outcome in traumatic high-grade cervical spinal dislocations.
  
  
  METHODS
  Retrospective analysis was performed involving two level 1 trauma centers. Patients with a high-grade traumatic cervical subluxation were selected from a database, and these patients were admitted between August 2007 and July 2011.
  
  
  RESULTS
  Fifteen patients were identified; three had spondyloptosis. The admission American Spinal Injury Association Impairment Scale (AIS) grade varied (A = 9; B = 2; C = 1; D = 2; E = 1). Fourteen patients underwent attempted closed reduction with six (43%) failing closed reduction. High-dose methylprednisolone was administered in nine patients (60%). All patients underwent surgical stabilization: three underwent anterior only, three underwent posterior only, and nine underwent a combined anterior-posterior approach. Postoperatively, one patient improved two AIS grades, three improved one AIS grade, nine maintained their preoperative score, and two patients worsened.
  
  
  CONCLUSIONS
  In this series, 26.7% of patients had improvement in their AIS grade postoperatively, and the majority of patients (60%) maintained their preoperative AIS grade. In 57% of patients placed in traction, reduction was possible. Likely due to the severity of these injuries, there was a high incidence of complications. However, review of patient outcomes reveals that these patients can have improvement of neurological function. We recommend aggressive reduction and surgical stabilization. Our preference is either a combined anterior-posterior approach or a posterior-only approach.
authors: Department of Neurosurgery, Emory University, Atlanta, Georgia, USA.
authors: Eric A
authors: EA
authors: Sribnick
authors: Department of Neurosurgery, University of Florida, Gainesville, Florida, USA.
authors: Daniel J
authors: DJ
authors: Hoh
authors: Department of Neurosurgery, Emory University, Atlanta, Georgia, USA. Electronic address: sanjaydhall@gmail.com.
authors: Sanjay S
authors: SS
authors: Dhall
mesh_terms: D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000293:injuries* / Q000601:surgery*; D017586:Diskectomy; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009460:Neurologic Examination; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000628:therapy; D013123:Spinal Fusion; D016896:Treatment Outcome; D055815:Young Adult
keywords: Cervical spondylolisthesis; Cervical spondyloptosis; Cervical traction; Spinal cord injury; Spinal instrumentation