In gratitude of the loyal support of our members, the CNS is offering complimentary 2021 Annual Meeting registration to all members! Learn more.

  • Bilateral Posterior Circulation Infarctions After Weighted Traction For Closed Reduction of a Cervical Spinal Fracture-Dislocation: A Case Report & Review of the Literature

    Final Number:
    343

    Authors:
    Rudy D Marciano DO; Chris S. Karas MD

    Study Design:
    Other

    Subject Category:
    Ischemic Stroke

    Meeting: AANS/CNS Cerebrovascular Section 2016 Annual Meeting

    Introduction: This case report documents the first reported case of suspected vascular injury and resultant bilateral posterior circulation infarctions after implementation of weighted traction for closed reduction of a cervical spinal fracture-dislocation injury.

    Methods: Case Report.

    Results: Case Presentation: A 37 year old caucasian male pedestrian presented with a complete cervical spinal cord injury, C7-T1 jumped facets, a severe TBI, and multiple long bone fractures after being struck by a motor vehicle. CT angiogram of the neck on presentation revealed patent carotid and vertebral arteries. The patient was hemodynamically unstable and had multiple other injuries precluding immediate open reduction of the spine, so closed reduction of the jumped facets was attempted via weighted traction with incremental increases up to 69 lb. of traction. This amount of weight did not reduce the malaligned spine, so the procedure was discontinued and the weight was removed. Approximately 34 hours after traction commenced, the patient’s neurologic status declined precipitously. Imaging revealed bilateral posterior circulation distribution infarctions and diffuse cerebellar edema of uncertain etiology. Despite aggressive medical management and placement of an external ventricular catheter to treat the obstructive hydrocephalus, the patient’s neurologic status did not improve and care was withdrawn.

    Conclusions: This case illustrates a possible bilateral cervical vertebral artery injury with resultant posterior circulation infarctions which occurred in the peri-procedural period after weighted cervical traction. Cervical vascular injury after closed reduction of cervical spine fracture-dislocation injuries with weighted traction is previously unreported but may be a possible risk of the procedure. Further studies, including biomechanical cadaver testing, could be done to investigate the possibility of traction related vascular injury. The specificity of CT angiography in this setting is not 100%, so other etiologies including occult vascular injuries should be considered as well.

    Patient Care: This case report will inform spine practitioners that cervical vascular injury after closed reduction of cervical spine fracture-dislocation injuries with weighted traction is a possible risk of the procedure

    Learning Objectives: By the conclusion of this section, participants should be aware that weighted cervical traction for closed reduction of cervical spinal fracture-dislocation injuries may potentially be complicated by vascular injury and resultant ischemic infarctions.

    References: Gelb, D. E., Hadley, M. N., Aarabi, B., Dhall, S. S., Hurlbert, R. J., Rozzelle, C. J., Ryken, T. C., Theodore, N. and Walters, B. C. (2013) ‘Initial closed reduction of cervical spinal fracture-dislocation injuries’, Neurosurgery, 72, pp. 73–83. doi: 10.1227/neu.0b013e318276ee02. Grant, G., Mirza, S., Chapman, J., Winn, H., Newell, D., Jones, D. and Grady (1999) ‘Risk of early closed reduction in cervical spine subluxation injuries’, Journal of neurosurgery., (90). Jang, D., Kim, C., Lee, S. J. and Kim, J. (2014) ‘Delayed brain infarction due to bilateral vertebral artery occlusion which occurred 5 days after cervical trauma’, J Korean Neurosurg Soc, 56(2), pp. 141–5. Lauweryns, P. (2009) ‘Role of conservative treatment of cervical spine injuries’, Eur Spine J, 19(Suppl 1), pp. 23–6. Schellinger, P., Schwab, S., Krieger, D., Fiebach, J., Steiner, T., Hund, E., Hacke, W. and Meinck, H. (2001) ‘Masking of vertebral artery dissection by severe trauma to the cervical spine’, Spine., 3(26). Schellinger, P., Schwab, S., Krieger, D., Fiebach, J., Steiner, T., Hund, E., Hacke, W. and Meinck, H. (2001) ‘Masking of vertebral artery dissection by severe trauma to the cervical spine’, Spine., 3(26). Vaccaro, A., Falatyn, S., Flanders, A., Balderston, R., Northrup, B. and Cotler, J. (1999) ‘Magnetic resonance evaluation of the intervertebral disc, spinal ligaments, and spinal cord before and after closed traction reduction of cervical spine dislocations’, Spine., 12(24). Wimberley, D., Vaccaro, A., Goyal, N., Harrop, J., Anderson, D., Albert, T. and Hilibrand, A. (2005) ‘Acute quadriplegia following closed traction reduction of a cervical facet dislocation in the setting of ossification of the posterior longitudinal ligament: Case report’, Spine., 15(30).

We use cookies to improve the performance of our site, to analyze the traffic to our site, and to personalize your experience of the site. You can control cookies through your browser settings. Please find more information on the cookies used on our site. Privacy Policy