Delayed Surgical Treatment of Cervical Spine Injury in an Adolescent Patient

Introduction. Cervical spine injury is recognised as one of the most disabling types of vertebral column and spinal cord injuries. With a high level of disability, this type of injury remains quite rare among children. The main types of complications in this kind of injury include impaired regulations of the respiratory and cardiovascular systems, tetra- and paraparesis, and pelvic organ disorders. The analysis of recent publications indicated early surgery (in less than 24 hours) as the main condition for reducing post-traumatic complications.
Materials and methods. The paper presents a clinical case of delayed surgery (in more than 24 hours) performed in a 17-year-old patient who was admitted to hospital after a traffic accident. After diagnostic measures, according to indications, a delayed surgery was performed on day 3: anterior spine fusion at the level of C5-Th1 with the installation of a vertebral body endoprosthesis and fixation with a bone plate.
Results and discussion. The present case confirms the need for patients with combined spinal cord injury and mild traumatic brain injury to undergo a full range of diagnostic examinations including: brain and spine imaging, and, in the presence of compression and signs of spinal cord injury, MRI of the spinal cord (if necessary, the brain) at the level of injury. In the absence of gross structural damage to the brain, urgent decompression of the spinal cord and spine stabilization are indicated to eliminate the traumatic and spinal shock.
Conclusion. Mild traumatic brain injury cannot be considered a contraindication for delayed cervical spine surgery. The present case is indicative of early surgical treatment of spinal injury, especially of the cervical spine, without neurological onset. All diagnostic measures were performed in full. Despite the surgical treatment and rehabilitation measures, the neurological deficit in the patient was not completely eliminated and persisted after 1 year.

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