Disclosures: Jennifer D. Sloan, MD: No financial relationships or conflicts of interest

Case Diagnosis: Protective Effect of Previous Spine Surgery in Traumatic Cervical Spinal Cord Injury

Case Description or Program Description: A 39-year-old female with previous C5-7 anterior cervical discectomy and fusion (ACDF) in 2017 presented following a fall from 20 feet while hiking. She was life flighted to an outside hospital and found to have multiple cervical spine fractures which were surgically repaired with C4-T2 fusion and C7 laminectomy. Imaging also showed retropulsion of osseous fragments in the spinal canal at the lower C7 level deforming the ventral cord contour, and cord edema at C7-T1. On evaluation, she had right lower extremity monoparesis, urinary retention, and severe constipation. She initially had decreased sensation at T4 dermatome and below that returned to normal within 48 hours.

Setting: Major academic and referral center with Level I adult trauma

Assessment/Results: The patient was evaluated by orthopedic spine surgery who determined the residual weakness was likely related to initial cord compression and no further surgical intervention was indicated. She was transferred to the inpatient rehabilitation unit and ultimately discharged home with the ability to walk 250 feet at a modified independent level. Her bowel and bladder function returned to normal.

Discussion (relevance): Fractures through previous ACDF are rare and require significant force. This patient had an unusual presentation with dramatic functional recovery as the forces were concentrated at the inferior part of her previous fusion. Additionally, she had evidence of corticospinal tract involvement without spinothalamic involvement relating to the fragments affecting the ventral cord.

Conclusions: This case implies that the patient’s previous ACDF may have provided a “protective effect” as the injury was below the levels of her previous spine surgery and only damaged the ventral cord. Without this, the patient may have been more susceptible to a higher level of injury and damage to further anatomic regions of the cord with greater functional deficits.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/protective-effect-of-previous-spine-surgery-in-traumatic-cervical-spinal-cord-injury-a-case-report/