Chen Yi-Ren, Chan Alvin Y, Kumar Kevin K, Veeravagu Anand
Department of Neurosurgery, Stanford University Medical Center.
Medical College of Wisconsin.
Cureus. 2016 Nov 22;8(11):e888. doi: 10.7759/cureus.888.
Traumatic injury to an adjacent segment of a previously fused spine is a rare complication of scoliosis surgery. The adjacent spinal segments may be more vulnerable to traumatic fracture or dislocation due to increased strain. We present a patient with prior C2 to sacrum fusion who suffered a C2 fracture/dislocation after falling. A 52-year-old female with a previous C2 to the sacrum fusion for idiopathic scoliosis presented with severe and progressively worsening neck pain after multiple falls. Imaging showed anterior displacement of the C2 vertebral body, fracture of C2, and anterior subluxation of the C1-2 complex on C3. The patient underwent posterior occiput to cervical fusion and reduction of the C1-C2 complex. Our case describes a potential complication of long-segment fusion. Adjacent segments may be more prone to fracture-dislocation because of increased intradiscal pressure and strain. Clinicians should have a high suspicion of fractures in patients with prior spinal fusions in the setting of trauma.
先前融合脊柱的相邻节段发生创伤性损伤是脊柱侧弯手术的一种罕见并发症。由于应变增加，相邻脊柱节段可能更容易发生创伤性骨折或脱位。我们报告一例既往有C2至骶骨融合术的患者，其在摔倒后发生了C2骨折/脱位。一名52岁女性，既往因特发性脊柱侧弯接受了C2至骶骨融合术，在多次摔倒后出现严重且逐渐加重的颈部疼痛。影像学检查显示C2椎体向前移位、C2骨折以及C1-2复合体在C3上向前半脱位。该患者接受了枕后至颈椎融合术以及C1-C2复合体复位。我们的病例描述了长节段融合的一种潜在并发症。由于椎间盘内压力和应变增加，相邻节段可能更容易发生骨折脱位。临床医生对于有脊柱融合史的患者在创伤情况下应高度怀疑骨折。
