Tag Archive for: Fracture; Axis; Cruciate; Paralysis.

Volume 2 | Issue 1 | April-September 2021 | page: 48-51 | G D Tharadara

Authors: G D Tharadara [1]

[1] Department of Orthopaedics, Saviour Hospital, Navrangpura, Ahmedabad, Gujarat, India.

Address of Correspondence
Dr. G.D. Tharadara,
EX. Professor of Orthopaedics, Spine Consultant, Saviour Hospital, Navrangpura, Ahmedabad, Gujrat, India.
E-mail: drtharadara@rediffmail.com

Abstract

Introduction: Injuries of upper cervical spine many times associated with false localizing signs as a neurological deficit means there is a no clinic-radiological correlation. Purpose of this case report is to diagnose rare clinical presentation due to injury of pyramidal tract decussating at lower medulla.
Method and Materials: A 21 years old male patient presented with traumatic quadriplegia (Frankel-A). Primary treatment was given along with immobilization of neck with collar. Routine X-ray of cervical spine was taken. X-ray was showing shear fracture of C 2 vertebra with intact dens. Crucified tong was inserted. Methyl Prednisolon injection in proper dose within 8 hours was given. (NASCIS II)
CT SCAN was done to know exact fracture geometry. It was showing a fracture of C2 body in an oblique plane shearing off in one piece with the dens tilted towards right side and with subluxation of C1-C2 articular process on left side.
Clinically patient improved in 24 hours in form of 4/5 power grade in all limbs except left upper limb. Left upper limb shoulder and elbow muscle power was grade 2/5 and o/5 in hand. Bladder/bowel was improved. Even though there was a weakness of left upper limb, but reflexes were preserved remarkably (Cruciate paralysis as a false localizing sign).
Considering atypical unstable fracture, open indirect reduction of C-1-2 done from posteriorly and stabilization done with apofix clamps after fusion between C1-C2 posterior arches.
Result: Patient had Frankel grade-A on admission. At three months follow up patient had almost full neurological recovery except finger grip power grade was 4/5. On final follow up at 12 months, neurology improved to Frankel grade-E. He had no neck pain with mild restriction of rotation. X-ray of cervical spine in flexion-extension shows stability and fusion of C1-C2 posterior elements.
Conclusion: Atypical clinical presentation like cruciate paralysis as a false localizing sign should be kept in mind while dealing with fracture of upper cervical spine. As this fracture has good prognosis, proper treatment is needed. If close reduction is not achieved then open reduction and stabilization with fusion will provide early mobilization and faster neurological recovery.
Keywords: Fracture; Axis; Cruciate; Paralysis.

References

1. Hahnle UR, Wisniewski TF, Craig JB. Shear fracture through the body of the axis vertebra. Spine. 1999 Nov 1; 24(21): 2278-81
2. Levi AD, Tator CH, Bunge RP. Clinical syndromes associated with disproportionate weakness of the upper versus the lower extremities after cervical spinal cord injury. Neurosurgery. 1996 Jan; 38(1): 179-83; discussion 183-5.
3. Georgiadis D, Schulte-Mattler WJ. Cruciate paralysis or man-in-the-barrel syndrome? Report of a case of brachial diplegia. Acta Neurol Scand. 2002 Apr; 105(4): 337-40.
4. Hatzakis MJ Jr, Bryce N, Marino R. Cruciate paralysis, hypothesis for injury and recovery. Spinal Cord 2000 Feb; 38(2): 120-5.
5. Coleman, W. P., Benzel, E., Cahill, D. W., Ducker, T., Geisler, F., Green, B., Gropper, M. R., Goffin, J., Madsen, P. W., Maiman, D. J., Ondra, S. L., Rosner, M., Sasso, R. C., Trost, G. R., & Zeidman, S. (2000). A critical appraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury. Journal of spinal disorders, 13(3), 185-199. https://doi.org/10.1097/00002517-200006000-00001
6. Cruciate paralysis and hemiplegia cruciata: report of three cases. T Yayama, K Uchida, S Kobayashi, H Nakajima,C Kubota, R Sato & H Baba ,Spinal Cord volume 44, pages393–398(2006
7. Revisiting cruciate paralysis: A case report and systematic review. Benjamin Hopkins, Ryan Khanna, and Nader S Dahdaleh. J Craniovertebr Junction Spine. 2016 Oct-Dec; 7(4): 265–272. doi: 10.4103/0974-8237.193262
8. False Localizing Signs in Upper Cervical Spinal Cord Compression.William J. Sonstein, M.D., Patrick A. LaSala, M.D., W. Jost Michelsen, M.D., Stephen T. Onesti, M.D. Neurosurgery, Volume 38, Issue 3, March 1996, Pages 445–449, https://doi.org/10.1097/00006123-199603000-00004
9. J Neurosurg 73:850-858, 1990. Cruciate paralysis: a clinical and radiographic analysis of injuries to the cervicomedullary junction CURTIS A. DICKMAN, M.D., MARK N. HADLEY, M.D., CONRAD T. E. PAPPAS, M.D., PH.D., VOLKER K. H. SONNTA6, M.D., AND FRED H. GEISLER, M.D., PH.D.
10. Recovery from Cruciate Paralysis Due to Axial Subluxation from Metastatic Breast Carcinoma: A Case Report. Walter J. Faillace 1, Troy Guthrie. Breast J. 2000 Mar;6(2):139-142. doi: 10.1046/j.1524-4741.2000.98118.x

(Abstract) (Full Text HTML)      (Download PDF)

.