Fractures and dislocations of the cervicothoracic junction

Abstract

Presented is a retrospective review of case notes and all available imaging studies in seven patients with acute fractures-dislocations of the cervicothoracic junction. Imaging studies included radiographs (five cases), computed tomography (six cases), and magnetic resonance imaging (seven cases). The study group consisted of five men and two women with mean age at presentation of 43.6 years (range 25-69 years). Four patients had been in road traffic accidents, whereas three patients had had falls. Three patients sustained complete neurologic deficits with no recovery, whereas the remaining four had no abnormal neurology or mild deficit at presentation and were normal at final follow-up. The injury was missed initially in three cases. The commonest injury pattern was traumatic spondylolisthesis of C7 on T1 with multilevel neural arch fractures, resulting in increased anteroposterior canal dimensions (four cases). Bilateral pars fractures of C7 and pure facet dislocation were seen in one case each. Neurologic deficit was related to the degree of anterior displacement of C7 on T1. Fracture-dislocation at the cervicothoracic junction is a rare injury with a variation of injury patterns and neurologic outcome.