Early approach to cervical fracture/dislocation leads to a better outcome? Case report: Fracture with dislocation at C4 and C5.

Introduction: Fractures of the cervical vertebrae cause the greatest neurological damage and around 50% are caused by automobile accidents. Dislocation is defined as loss of contact between articular facets, in the case of the cervical spine (C2-C7), which can lead to unilateral or bilateral blockage of articular facets, causing neurological damage. The association of both occurrences is uncommon and represents a catastrophic event in neurological terms with poor survival, and the treatment considered can be either surgical or conservative depending on the condition. Objective: To report a case of an early surgical approach to a fracture and dislocation of the fourth and fifth cervical vertebrae and a good prognosis represented by a progressive reduction in neurological damage. Methodology: This is a descriptive observational study based on the analysis of the patient's medical record and literature review. Results: A 24-year-old man, the victim of a motorcycle/trailer accident, was admitted to the surgical emergency department wearing a neck brace, communicative and with signs of raccoon in his eyes, presenting with hematemesis on initial consultation, mental confusion and loss of movement, paresthesia and reduced movement in his lower limbs. Subarachnoid hematoma with sudden increase and fracture dislocation of C4 and C5 vertebrae. Right upper limb with fallen hand sign. Surgery was performed to drain the laminar and subdural hematoma on the left + surgical treatment of the C4/C5 fracture/dislocation. The patient moved to an intensive care bed, ventilating on room air and requiring the use of vasoactive drugs with gradual weaning. On the 7th post-operative day, he was able to flex and extend his wrists and elbows, as well as having pincer mobility bilaterally. In her lower limbs, she still had paraplegia, paresthesia and preserved sensitivity. Due to hemodynamic stability, the patient was discharged from hospital and continued to be followed up as an outpatient. After 20 days of surgery, the patient showed slight active mobilization of the left hallux. After 35 days, she had grade 2 strength in the left lower limb and grade 0 in the right lower limb. After 80 days, she had grade 4 strength in the left lower limb and grade 2 in the right lower limb. 4 months later, she had grade 4 strength in the bilateral lower limb and improved range of motion. 10 months after surgery, the patient returned to the outpatient clinic without a wheelchair, walking unaided, with preserved strength in the upper and lower limbs and preserved sensitivity. Conclusion: Our case in question shows an early surgical approach and a progressive improvement in lower limb paraplegia over the months, returning to maximum strength and preserved sensitivity after surgical treatment of the cervical dislocation/fracture.