Anterior Transpedicular Screw-Plate System Fixation in the Lower Cervical Spine Fracture Complicated by Spinal Cord Injury: A Case Report

A multilevel contiguous fracture of the subaxial cervical spine represents the severe trauma, and anterior plate fixation with anterior transpedicular screw fixation is a new and reliable fixation pattern for the treat-ment of acute spinal cord injury (ASCI). We present a case of multilevel contiguous fractures in the lower cervical spine without obvious posterior ligamentous complex injury, but with complete quadriplegia due to a falling accident. Computed tomography revealed multilevel contiguous fractures of the subaxial cer-vical spine including a posterior arch of atlas fracture with the sclerites of C5 vertebral body into the spinal canal with a major compression of the left anterior side of the cord. The patient was treated with a late surgery of C5, C6 corpectomies followed by a autologous bone graft with titanium mesh and surgical stabiliza tion of anterior transpedicular screw-plate system (ATPSP) through anterior approach only. At 1 year postoperative, the patient showed slight improvement except for urinary and fecal incontinence. The finger strength improved to grade 1 of 5 bilaterally, and muscular strength of lower extremities was grade 1 of 5 bilaterally. The latest followup showed the patient paralyzed without any further improvement at 2 years post operative. Anterior cervical plate fixation with anterior transpedicular screw fixation provides a new route of how to treat multilevel fractures of the subaxial cervical spine, and it is feasible. Surgical intervention provides rigid fixation and facilitates early rehabilitation, but the functional recovery of traumatic cervical spinal cord injury remains a difficult problem.