Article
Quadriplegia after trauma of the cervical spine without radiographic signs of injury – immediate surgery or wait and see?
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Authors
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Bettina Knie
- Klinik für Neurochirurgie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
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Jörn Leibling
- Klinik für Neurochirurgie, Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
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Dag Moskopp
- Vivantes-Klinikum im Friedrichshain Berlin, Klinik für Neurochirurgie, Berlin, Deutschland
| Published: | June 9, 2017 |
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Outline
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Objective: Spinal concussion is defined by a transient neurological deficit without signs of instability or structural damage. A constitutionally or degeneratively narrow spinal canal is a predisposal condition, which can have a pincer like impact on the spinal cord in case of flexion-/extension trauma. Neurological deficits range from paresthesia to incomplete or complete paralysis.
Methods: A 30 year old rugby player and trainer has been hit by another player who was jumping into his neck while he was squatted. Afterwards was unable to move and had severe back pain. The movement of both arms was impaired and he had paresthesia of the lower limbs. The clinical examination in our rescue center revealed proximal accentuated high grade palsy of the upper and lower limbs and a hypesthesia from th2 level. The CT scan showed no traumatic injury but the cervical canal was constricted with a remaining sagittal width of eight mm. Under the suspicion of a cervical spinal cord injury a complimentary MRI has been performed. In the MRI there were signs of a cervical spinal cord edema. Additionally a disc herniation at C5/C6 level without nerve root or spinal cord compression has been revealed. In the course of the initial emergency diagnostics the paresthesia and paralysis has been markedly reduced and the primarily considered surgery has been postponed. The patient was admitted to the intensive care unit for further surveillance. During the day the neurological deficit continuously improved.
Results: After 48 hours there was a complete regress of the high grade paralysis. Radiographic signs of spinal cord edema have not been seen anymore. The clinical follow up after two and eight weeks showed a stable result. Because of the constitutionally narrow spinal canal the patient was recommended to avoid sports with physical contact and a follow up MRI scan.
Conclusion: Due to constitutional and/or degenerative impairments of the cervical spine an isolated spinal cord concussion can lead to a transient quadriplegia. If there are no other injuries a wait and see strategy with close monitoring and clinical surveillance is an appropriate therapy option.
